Provider Demographics
NPI:1740435510
Name:PANSARASA, CORI L (PSYD)
Entity type:Individual
Prefix:DR
First Name:CORI
Middle Name:L
Last Name:PANSARASA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 MIRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1741
Mailing Address - Country:US
Mailing Address - Phone:510-407-1006
Mailing Address - Fax:
Practice Address - Street 1:2008 MIRA VISTA DR
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1741
Practice Address - Country:US
Practice Address - Phone:510-407-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical