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General NPI Number Information
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NPI Number | 1134950405
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Entity Type | Organization
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Legal Business Name | MANEESH SURESH PENKAR MD INC
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 3701 SKYPARK DR STE 105
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City | TORRANCE
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State | CA
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Zip | 90505-4712
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Country | US
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Telephone | 310-897-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 SKYPARK DR STE 105
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City | TORRANCE
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State | CA
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Zip | 90505-4712
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Country | US
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Telephone | 310-897-8272
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | MANEESH SURESH PENKAR
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Credential | MD
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Telephone | 310-897-8272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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