Provider Demographics
NPI:1215043484
Name:PANACEA, INC
Entity Type:Organization
Organization Name:PANACEA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-875-6962
Mailing Address - Street 1:3353 BRADSHAW RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2608
Mailing Address - Country:US
Mailing Address - Phone:916-854-4564
Mailing Address - Fax:916-857-1580
Practice Address - Street 1:3353 BRADSHAW RD STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2608
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:916-857-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty