Provider Demographics
NPI:1982967550
Name:PANGAN, DEANNA CAPILI (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:CAPILI
Last Name:PANGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 RIDGETREE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1942
Mailing Address - Country:US
Mailing Address - Phone:408-887-0357
Mailing Address - Fax:
Practice Address - Street 1:1786 RIDGETREE WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1942
Practice Address - Country:US
Practice Address - Phone:408-887-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist