Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC20484 | CA |
NPI | 1023337201 |
---|---|
Provider Name | Dr. Michael Hector Penilla |
First Address | Colton, CA 92324-2455 |
Second Address | Colton, CA 92324-2455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2010 |
Last Update Date | 26/05/2010 |