Provider Demographics
NPI:1992936678
Name:PANOVA, ANGELIKA (MHPNP-RN/ LMFT)
Entity type:Individual
Prefix:
First Name:ANGELIKA
Middle Name:
Last Name:PANOVA
Suffix:
Gender:F
Credentials:MHPNP-RN/ LMFT
Other - Prefix:
Other - First Name:ANGELIKA
Other - Middle Name:
Other - Last Name:PANOVA BOHANNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHPNP-RN/ LMFT
Mailing Address - Street 1:1057 E IMPERIAL HWY
Mailing Address - Street 2:APT 226
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1717
Mailing Address - Country:US
Mailing Address - Phone:951-215-0881
Mailing Address - Fax:951-215-0881
Practice Address - Street 1:7057 GASKIN PL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5615
Practice Address - Country:US
Practice Address - Phone:714-887-3816
Practice Address - Fax:209-203-1061
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49586106H00000X
CA95004867363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist