Healthcare Provider Details

I. General information

NPI: 1528515020
Provider Name (Legal Business Name): PENELOPE MACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8233 E. STOCKTON BLVD
SACRAMENTO CA
95828
US

IV. Provider business mailing address

216 NUNZIA COURT
ROSEVILLE CA
95661
US

V. Phone/Fax

Practice location:
  • Phone: 916-550-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number850326
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number850326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: