Provider Demographics
NPI:1063746998
Name:PANZAR, ATHENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:
Last Name:PANZAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DELTA FAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4004
Mailing Address - Country:US
Mailing Address - Phone:925-779-5090
Mailing Address - Fax:
Practice Address - Street 1:3400 DELTA FAIR BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4004
Practice Address - Country:US
Practice Address - Phone:925-779-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health