Organization
DAPHNE I PANAGOTACOS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBBIE ICKES (PRACTICE ADMINISTRATOR)
(805) 379-3376
Entity
Organization
Contact information
Practice address
32144 AGOURA RD, SUITE 106, WESTLAKE VILLAGE, CA 91361-4031
(805) 379-3376
(805) 379-3267
Mailing address
32144 AGOURA RD, SUITE 106, WESTLAKE VILLAGE, CA 91361-4031
(805) 379-3376
(805) 379-3267
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
G66971
CA
207ND0900X
Dermatopathology Physician
Primary
G66971
CA
207NP0225X
Pediatric Dermatology Physician
G66971
CA
Other
Enumeration date
07/18/2008
Last updated
07/31/2012
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