Provider Demographics
NPI:1780210039
Name:PANITZ, SHOSHANA (AGPCNP)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:PANITZ
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12512 CHANDLER BLVD APT 118
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1971
Mailing Address - Country:US
Mailing Address - Phone:323-979-6694
Mailing Address - Fax:
Practice Address - Street 1:2221 LINCOLN PARK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2920
Practice Address - Country:US
Practice Address - Phone:323-276-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012859363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology