Healthcare Provider Details

I. General information

NPI: 1023337201
Provider Name (Legal Business Name): MICHAEL HECTOR PENILLA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 N LA CADENA DR SUITE 1
COLTON CA
92324-2455
US

IV. Provider business mailing address

1265 N LA CADENA DR SUITE 1
COLTON CA
92324-2455
US

V. Phone/Fax

Practice location:
  • Phone: 909-423-0000
  • Fax:
Mailing address:
  • Phone: 909-423-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC20484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: