Provider Demographics
NPI:1134395932
Name:AVILA-PANDEY, ANGELINA FRAUSTO (MFT)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:FRAUSTO
Last Name:AVILA-PANDEY
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:PO BOX 20071
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160-0071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15951 LOS GATOS BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3488
Practice Address - Country:US
Practice Address - Phone:408-358-9396
Practice Address - Fax:408-358-3711
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist