Healthcare Provider Details

I. General information

NPI: 1144546748
Provider Name (Legal Business Name): DAVID L PENNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/03/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 EDITH AVE
REDDING CA
96001-3030
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-2882
  • Fax: 530-244-3703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number136296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: