Provider Demographics
NPI:1902528854
Name:PANGANIBAN, FAYE (NP-C)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10629 LA VINA LN
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-4378
Mailing Address - Country:US
Mailing Address - Phone:562-322-2444
Mailing Address - Fax:
Practice Address - Street 1:10629 LA VINA LN
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-4378
Practice Address - Country:US
Practice Address - Phone:562-322-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily