MEDICARE: DR. ANDERSON DA PAZ PENHA MD, MAS

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	261QX0100X	Occupational Medicine Clinic/Center	A204882	CA
2	208VP0000X	Pain Medicine Physician	A204882	CA
3	207P00000X	Emergency Medicine Physician	A204882	CA

General Provider Information

NPI Number	:	1336601426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDERSON DA PAZ PENHA MD, MAS

Provider Business Mailing Address
First Line	:	501 N REO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 IMPERIAL HWY STE 100
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-1020
Country	:	US
Telephone Number	:	714-770-8400
Fax Number	:

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

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	03/03/2026

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