Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME39077 | FL |
N | 207VX0000X | Obstetrician | ME39077 | FL |
NPI | 1104811165 |
---|---|
Provider Name | Christine Penso |
First Address | Fort Lauderdale, FL 33316 |
Second Address | Fort Lauderdale, FL 33316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 15/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013244200 | (05) | FL |
3003388 | (05) | MA |
B74643 | (02) |