Healthcare Provider Details

I. General information

NPI: 1821301425
Provider Name (Legal Business Name): MACHTEL M PENGEL ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 12/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EXECUTIVE PARK BLVD SUITE 4000
SAN FRANCISCO CA
94134-3303
US

IV. Provider business mailing address

4966 EL CAMINO REAL STE 224
LOS ALTOS CA
94022-1436
US

V. Phone/Fax

Practice location:
  • Phone: 415-715-1050
  • Fax: 415-715-1051
Mailing address:
  • Phone: 650-690-2362
  • Fax: 650-590-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 23013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: