Healthcare Provider Details

I. General information

NPI: 1154344927
Provider Name (Legal Business Name): STEFAN I PENTSCHEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E PINE ST
EXETER CA
93221-1838
US

IV. Provider business mailing address

330 E PINE ST
EXETER CA
93221-1838
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-2134
  • Fax: 559-592-5017
Mailing address:
  • Phone: 559-592-2134
  • Fax: 559-592-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA43893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: