Provider Demographics
NPI:1508082702
Name:PANTTI-DULBERG, NATASHA EDWINA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:EDWINA
Last Name:PANTTI-DULBERG
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:EDWINA
Other - Last Name:PANTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF
Mailing Address - Street 1:5252 BALBOA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6906
Mailing Address - Country:US
Mailing Address - Phone:858-492-7125
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6906
Practice Address - Country:US
Practice Address - Phone:858-492-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist