NPI 1164738464

Jacob Panquale Panzarella, PHD

Practitioner Clinical Neuropsychologist San Rafael, CA

Practice location

Address: 4040 Civic Center Dr Suite 200, San Rafael, CA 94903-4150
Phone: (415) 381-0300
Fax: (415) 898-4361
Mailing address: 775 E Blithedale Ave Box 402, Mill Valley, CA 94941-1554

Registered specialties

Clinical Neuropsychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103G00000X Licence PSY3581 (CA)

Other Clinical Neuropsychologist providers in California →

Registry record

NPI: 1164738464
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Aug 2010
Record last updated: 24 Aug 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.