Provider Demographics
NPI:1467636118
Name:PANGANIBAN, ALLISON ESPINOSA
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ESPINOSA
Last Name:PANGANIBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4993 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2146
Mailing Address - Country:US
Mailing Address - Phone:617-413-6537
Mailing Address - Fax:
Practice Address - Street 1:4993 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-2146
Practice Address - Country:US
Practice Address - Phone:617-413-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA071676390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program