MEDICARE: CHARLES VINCENT PANVINI

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	103T00000X	Psychologist	PSY34820	CA

General Provider Information

NPI Number	:	1679437198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES VINCENT PANVINI

Provider Business Mailing Address
First Line	:	131 N EL MOLINO AVE STE 310
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1878
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 THOMPSON AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1442
Country	:	US
Telephone Number	:	818-245-5362
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ CHARLES VINCENT PANVINI ” Practice Location

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