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General NPI Number Information
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NPI Number | 1134285430
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Entity Type | Individual
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Provider Name | JERI L PENKAVA MD
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 84 NE LOOP 410 STE 245
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City | SAN ANTONIO
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State | TX
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Zip | 78216-5802
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Country | US
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Telephone | 210-403-2343
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Fax | 210-403-2350
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Provider Business Mailing Address
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Address Line | 323 OGDEN LN
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City | SAN ANTONIO
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State | TX
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Zip | 78209-5138
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Country | US
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Telephone | 210-403-2343
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Fax | 210-403-2350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G4242
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | G4242
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License Number State | TX
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