Provider Demographics
NPI:1801768007
Name:PANIZO JANSANA, MARIAFE TEVI (DR)
Entity type:Individual
Prefix:
First Name:MARIAFE
Middle Name:TEVI
Last Name:PANIZO JANSANA
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHIELDS AVE RM 219
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-8500
Mailing Address - Country:US
Mailing Address - Phone:540-752-0871
Mailing Address - Fax:
Practice Address - Street 1:1 SHIELDS AVE RM 219
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-8500
Practice Address - Country:US
Practice Address - Phone:540-752-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34262101YM0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health