Healthcare Provider Details

I. General information

NPI: 1750245023
Provider Name (Legal Business Name): ANTHONY PENCE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 CA-18
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

13172 KEOKUK ST
VICTORVILLE CA
92395-5516
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95388786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: