Provider Demographics
NPI:1104252352
Name:PANOS, STELLA (PHD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:PANOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WILSHIRE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1737
Mailing Address - Country:US
Mailing Address - Phone:562-964-1906
Mailing Address - Fax:
Practice Address - Street 1:720 WILSHIRE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1737
Practice Address - Country:US
Practice Address - Phone:424-345-6377
Practice Address - Fax:800-387-6076
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25723103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical