MEDICARE: GRAYSEN PANGANIBAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336006162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAYSEN PANGANIBAN

Provider Business Mailing Address
First Line	:	19220 AUTUMN WOODS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19220 AUTUMN WOODS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3068
Country	:	US
Telephone Number	:	813-600-7397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ GRAYSEN PANGANIBAN ” Practice Location

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