Provider Demographics
NPI:1700762259
Name:PANAMENO, INGRID PAOLA
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:PAOLA
Last Name:PANAMENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 DUNSMUIR CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2992
Mailing Address - Country:US
Mailing Address - Phone:972-537-6489
Mailing Address - Fax:
Practice Address - Street 1:5028 DUNSMUIR CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2992
Practice Address - Country:US
Practice Address - Phone:972-537-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7377405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional