Healthcare Provider Details

I. General information

NPI: 1851928121
Provider Name (Legal Business Name): JUAN FIDEL PENALOZA PACHECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN FIDEL PENALOZA

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DR
VACAVILLE CA
95687
US

IV. Provider business mailing address

1600 CALIFORNIA DR
VACAVILLE CA
95687
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA178289
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License NumberA178289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: