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General NPI Number Information
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NPI Number | 1154283521
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Entity Type | Individual
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Provider Name | SERGIO PENUNURI II RN
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 215 W 9TH ST
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City | UPLAND
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State | CA
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Zip | 91786-5910
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Country | US
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Telephone | 909-476-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 1852 EVELYN CIR
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City | COLTON
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State | CA
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Zip | 92324-1311
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Country | US
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Telephone | 909-965-2661
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Fax |
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 95298171
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License Number State | CA
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