Healthcare Provider Details

I. General information

NPI: 1992936678
Provider Name (Legal Business Name): ANGELIKA PANOVA MHPNP-RN/ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELIKA PANOVA BOHANNAN MHPNP-RN/ LMFT

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 GASKIN PL
RIVERSIDE CA
92506-5615
US

IV. Provider business mailing address

1057 E IMPERIAL HWY APT 226
PLACENTIA CA
92870-1717
US

V. Phone/Fax

Practice location:
  • Phone: 714-887-3816
  • Fax: 209-203-1061
Mailing address:
  • Phone: 951-215-0881
  • Fax: 951-215-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49586
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95004867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: