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NPI Code Detail

MEDICARE: KEVIN STEVEN PANAMENO M.ED

MEDICARE: KEVIN STEVEN PANAMENO M.ED
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1497351365
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN STEVEN PANAMENO M.ED
Provider Business Mailing Address
First Line : 3303 HARBOR BLVD STE B10
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-1537
Country : US
Telephone Number : 714-786-6069
Fax Number :
Provider Business Practice Location Address
First Line : 3303 HARBOR BLVD STE B10
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-1537
Country : US
Telephone Number : 714-786-6069
Fax Number : 714-834-9822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2020
Last Update Date : 12/07/2020

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