Provider Demographics
NPI:1851158638
Name:PANZARINO, RANDY WILLIAM (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:WILLIAM
Last Name:PANZARINO
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34081 COPPER LANTERN ST APT B
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2613
Mailing Address - Country:US
Mailing Address - Phone:321-604-5204
Mailing Address - Fax:
Practice Address - Street 1:33122 VALLE RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4859
Practice Address - Country:US
Practice Address - Phone:949-234-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist