Provider Demographics
NPI:1477846483
Name:PANAMENO, KARLA MARIA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MARIA
Last Name:PANAMENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 N DITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-3736
Mailing Address - Country:US
Mailing Address - Phone:213-840-9651
Mailing Address - Fax:
Practice Address - Street 1:1721 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3312
Practice Address - Country:US
Practice Address - Phone:323-221-4134
Practice Address - Fax:323-221-4231
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW628271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical