Healthcare Provider Details

I. General information

NPI: 1093967747
Provider Name (Legal Business Name): PENSIRI SAHATRUNGSINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PENNY SAHATRUNGSINEE P.A.

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD UNIT 25
PASADENA CA
91105-3010
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD UNIT 25
PASADENA CA
91105-3010
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-4577
  • Fax:
Mailing address:
  • Phone: 310-795-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: