Provider Demographics
NPI:1427181528
Name:PANSTER, PETRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:PANSTER
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 1:21380 CENTRE POINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3050
Mailing Address - Country:US
Mailing Address - Phone:661-383-1805
Mailing Address - Fax:661-254-8653
Practice Address - Street 1:21380 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350
Practice Address - Country:US
Practice Address - Phone:661-286-2550
Practice Address - Fax:661-286-2567
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical