Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G15621 | CA |
NPI | 1003836495 |
---|---|
Provider Name | George H Penn |
First Address | Monterey, CA 93940-4321 |
Second Address | Monterey, CA 93940-5334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 19/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A39577 | (02) | CA |