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General NPI Number Information
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NPI Number | 1003626458
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Entity Type | Organization
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Legal Business Name | JOHN CORNELIUS PENNER, MD
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 69 HERNANDEZ AVE
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City | LOS GATOS
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State | CA
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Zip | 95030-5844
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Country | US
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Telephone | 408-204-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 69 HERNANDEZ AVE
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City | LOS GATOS
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State | CA
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Zip | 95030-5844
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Country | US
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Telephone | 408-204-6990
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | TRACI CROSBY
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Credential |
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Telephone | 715-490-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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