Provider Demographics
NPI:1396001426
Name:PAMVAS, INC.
Entity Type:Organization
Organization Name:PAMVAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VISANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANATHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-779-2437
Mailing Address - Street 1:12223 HIGHLAND AVENUE, SUITE 544
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2574
Mailing Address - Country:US
Mailing Address - Phone:855-779-2437
Mailing Address - Fax:855-771-4950
Practice Address - Street 1:12223 HIGHLAND AVENUE, SUITE 544
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2574
Practice Address - Country:US
Practice Address - Phone:855-779-2437
Practice Address - Fax:855-771-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty