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1275627655

NPI Code Detail

MEDICARE: DR. MICHELLE P PENT MD

MEDICARE: DR. MICHELLE P PENT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD2005-0225	NM
2	2084P0800X	Psychiatry Physician	C55145	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275627655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE P PENT MD

Provider Business Mailing Address
First Line	:	3853 ROSECRANS ST
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3115
Country	:	US
Telephone Number	:	619-692-8232
Fax Number	:	619-542-4060

Provider Business Practice Location Address
First Line	:	3853 ROSECRANS ST
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3115
Country	:	US
Telephone Number	:	619-692-8232
Fax Number	:	619-542-4060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/14/2013

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Directions to “ DR. MICHELLE P PENT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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