Provider Demographics
NPI:1033804851
Name:PANGANIBAN, ALYSSA (DO)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2139
Mailing Address - Country:US
Mailing Address - Phone:630-397-8631
Mailing Address - Fax:
Practice Address - Street 1:1775 BALLARD RD FL 2
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1005
Practice Address - Country:US
Practice Address - Phone:847-318-6020
Practice Address - Fax:847-318-2341
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program