Provider Demographics
NPI:1063731909
Name:PAN-SIFER COMMUNICATIONS SERVICES NETWORK, INC.
Entity type:Organization
Organization Name:PAN-SIFER COMMUNICATIONS SERVICES NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIRKO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:310-291-1998
Mailing Address - Street 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 558
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:310-291-2998
Mailing Address - Fax:626-797-7492
Practice Address - Street 1:2118 WILSHIRE BLVD
Practice Address - Street 2:SUITE 558
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5704
Practice Address - Country:US
Practice Address - Phone:310-291-2998
Practice Address - Fax:626-797-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC1774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty