Healthcare Provider Details

I. General information

NPI: 1477970614
Provider Name (Legal Business Name): PENELOPE CADIGAN LIBEU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 IRON POINT RD STE 210
FOLSOM CA
95630-8713
US

IV. Provider business mailing address

2365 IRON POINT RD STE 210
FOLSOM CA
95630-8713
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA155290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: