Provider Demographics
NPI:1033369814
Name:HANKIN, PENELOPE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:J
Last Name:HANKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 W 25TH ST
Mailing Address - Street 2:#100
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4901
Mailing Address - Country:US
Mailing Address - Phone:310-519-7121
Mailing Address - Fax:
Practice Address - Street 1:4901 MORENA BLVD
Practice Address - Street 2:STE. 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3423
Practice Address - Country:US
Practice Address - Phone:858-272-3992
Practice Address - Fax:858-272-3804
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical