Provider Demographics
NPI:1558490631
Name:PANDES, MARIAM (MFT)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:PANDES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 KEARNY VILLA RD
Mailing Address - Street 2:STE.116
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1578
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:619-516-4757
Practice Address - Street 1:15525 POMERADO RD
Practice Address - Street 2:#A-7
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:619-516-4757
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist