Healthcare Provider Details

I. General information

NPI: 1437827003
Provider Name (Legal Business Name): CHRISTINE PANKOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 PACIFIC HEIGHTS BLVD SUITE 150
SAN DIEGO CA
92121-4396
US

IV. Provider business mailing address

9920 PACIFIC HEIGHTS BLVD SUITE 150
SAN DIEGO CA
92121-4396
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-8169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26-QMHA-R-9145
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number26-QMHA-R-9145
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: