MEDICARE: MARIAFE TEVI PANIZO JANSANA DR

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	101YM0800X	Mental Health Counselor	PSY34262	CA
2	103TC0700X	Clinical Psychologist	PSY34262	CA

General Provider Information

NPI Number	:	1801768007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAFE TEVI PANIZO JANSANA DR

Provider Business Mailing Address
First Line	:	1 SHIELDS AVE RM 219
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-8500
Country	:	US
Telephone Number	:	540-752-0871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SHIELDS AVE RM 219
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-8500
Country	:	US
Telephone Number	:	540-752-0871
Fax Number	:

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

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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