Healthcare Provider Details

I. General information

NPI: 1831823103
Provider Name (Legal Business Name): MR. VICTOR PANNU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 BUSINESS DR
SACRAMENTO CA
95820-2197
US

IV. Provider business mailing address

1517 H ST.
SACRAMENTO CA
95814
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8396
  • Fax:
Mailing address:
  • Phone: 213-444-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35538
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: