Provider Demographics
NPI:1053477133
Name:PANDELAERS, PETRA NALINI (MA)
Entity Type:Individual
Prefix:MRS
First Name:PETRA
Middle Name:NALINI
Last Name:PANDELAERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 AVENIDA DE LOS LOBOS APT H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2232
Mailing Address - Country:US
Mailing Address - Phone:858-672-1719
Mailing Address - Fax:
Practice Address - Street 1:11305 AVENIDA DE LOS LOBOS APT H
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2232
Practice Address - Country:US
Practice Address - Phone:858-672-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health