Individual
DR. JACOB PANQUALE PANZARELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4040 CIVIC CENTER DR, SUITE 200, SAN RAFAEL, CA 94903-4150
(415) 381-0300
(415) 898-4361
Mailing address
775 E BLITHEDALE AVE, BOX 402, MILL VALLEY, CA 94941-1554
(415) 381-0300
(415) 898-4361
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY3581
CA
Other
Enumeration date
08/24/2010
Last updated
08/24/2010
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