Healthcare Provider Details

I. General information

NPI: 1154828465
Provider Name (Legal Business Name): JOSEPH LAPENNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR STE 300
SANTA ROSA CA
95405-4559
US

IV. Provider business mailing address

500 DOYLE PARK DR STE 300
SANTA ROSA CA
95405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-8320
  • Fax:
Mailing address:
  • Phone: 707-303-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA186935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: