Provider Demographics
NPI:1194892661
Name:PANCHENKO, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PANCHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W VISTA WAY
Mailing Address - Street 2:206
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5732
Mailing Address - Country:US
Mailing Address - Phone:760-724-9112
Mailing Address - Fax:
Practice Address - Street 1:550 W VISTA WAY
Practice Address - Street 2:206
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5732
Practice Address - Country:US
Practice Address - Phone:760-724-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health