Provider Demographics
NPI:1457452088
Name:PANGAN, ELOISA GUECO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELOISA
Middle Name:GUECO
Last Name:PANGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16344 TULSA ST.
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-366-1531
Mailing Address - Fax:
Practice Address - Street 1:14600 SHERMAN WAY
Practice Address - Street 2:300
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:818-781-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine