Healthcare Provider Details

I. General information

NPI: 1831270362
Provider Name (Legal Business Name): RAFAEL ARTURO PENUNURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/04/2024
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 SUPERIOR AVE STE#1
NEWPORT BEACH CA
92663-2723
US

IV. Provider business mailing address

1419 SUPERIOR AVE STE#1
NEWPORT BEACH CA
92663
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-0587
  • Fax: 949-631-8155
Mailing address:
  • Phone: 949-650-0587
  • Fax: 949-631-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG50737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: