Healthcare Provider Details

I. General information

NPI: 1225136880
Provider Name (Legal Business Name): MARTIN B PENNINGTON II PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AVENIDA SERRA
SAN CLEMENTE CA
92672-4760
US

IV. Provider business mailing address

503 MONTEREY LN APARTMENT D
SAN CLEMENTE CA
92672-5340
US

V. Phone/Fax

Practice location:
  • Phone: 949-510-3845
  • Fax:
Mailing address:
  • Phone: 949-510-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSB26001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB26011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: