Provider Demographics
NPI:1174194021
Name:PANGGA, CHRISTINE ARAMBULO
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ARAMBULO
Last Name:PANGGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18315 ARLINE AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5713
Mailing Address - Country:US
Mailing Address - Phone:562-219-1203
Mailing Address - Fax:
Practice Address - Street 1:18315 ARLINE AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5713
Practice Address - Country:US
Practice Address - Phone:562-219-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87056126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87056Medicaid