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General NPI Number Information
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NPI Number | 1558490631
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Entity Type | Individual
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Provider Name | MARIAM PANDES MFT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15525 POMERADO RD #A-7
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-279-1223
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Fax | 619-516-4757
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Provider Business Mailing Address
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Address Line | 4550 KEARNY VILLA RD STE.116
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City | SAN DIEGO
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State | CA
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Zip | 92123-1578
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Country | US
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Telephone | 858-279-1223
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Fax | 619-516-4757
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MFC44014
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License Number State | CA
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