Provider Demographics
NPI:1942172440
Name:PANUCO, JUDITH ADRIANA (PPS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ADRIANA
Last Name:PANUCO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BAHIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4502
Mailing Address - Country:US
Mailing Address - Phone:415-485-2473
Mailing Address - Fax:
Practice Address - Street 1:125 BAHIA WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4502
Practice Address - Country:US
Practice Address - Phone:415-485-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor