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General NPI Number Information
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NPI Number | 1376260471
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Entity Type | Organization
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Legal Business Name | PANGANIBAN MARRIAGE AND FAMILY THERAPY INC.
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 16935 W BERNARDO DR STE 122
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City | SAN DIEGO
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State | CA
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Zip | 92127-1623
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Country | US
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Telephone | 858-868-5558
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Fax |
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Provider Business Mailing Address
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Address Line | 13223 BLACK MOUNTAIN RD # 346
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City | SAN DIEGO
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State | CA
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Zip | 92129-2698
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. KIMBERLY DIRKS PANGANIBAN
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Credential | LMFT
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Telephone | 858-361-6016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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