Provider Demographics
NPI:1114537685
Name:MARTIN, PANG F
Entity Type:Individual
Prefix:
First Name:PANG
Middle Name:F
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PANG
Other - Middle Name:F
Other - Last Name:THAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9409 EMERALD VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1721
Mailing Address - Country:US
Mailing Address - Phone:916-947-4443
Mailing Address - Fax:
Practice Address - Street 1:3101 I ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4421
Practice Address - Country:US
Practice Address - Phone:916-947-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health