Healthcare Provider Details

I. General information

NPI: 1932321643
Provider Name (Legal Business Name): MONTE WINSTON PENNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 SUNRISE AVE STE 602
ROSEVILLE CA
95661-4542
US

IV. Provider business mailing address

PO BOX 923
WEIMAR CA
95736-0923
US

V. Phone/Fax

Practice location:
  • Phone: 916-953-7571
  • Fax: 916-771-8515
Mailing address:
  • Phone: 916-215-1531
  • Fax: 916-481-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG71997
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG71997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: