Healthcare Provider Details

I. General information

NPI: 1487179107
Provider Name (Legal Business Name): THOMAS PENAFLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

11278 LUKE ST
RIVERSIDE CA
92505-2590
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2428
  • Fax: 310-787-4376
Mailing address:
  • Phone: 714-501-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: