Healthcare Provider Details

I. General information

NPI: 1558316083
Provider Name (Legal Business Name): BRIAN SCOTT PENTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BISHOP ST BLDG A STE 110
SAN LUIS OBISPO CA
93401-4692
US

IV. Provider business mailing address

1551 BISHOP ST BLDG A STE 110
SAN LUIS OBISPO CA
93401-4692
US

V. Phone/Fax

Practice location:
  • Phone: 805-548-8585
  • Fax: 805-548-8589
Mailing address:
  • Phone: 805-548-8585
  • Fax: 805-548-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA84188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: