Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G33760 | CA |
NPI | 1144528084 |
---|---|
Provider Name | Dr. Richard Daniel Della Penn |
First Address | San Diego, CA 92101 |
Second Address | San Diego, CA 92101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 02/03/2011 |