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General NPI Number Information
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NPI Number | 1275879017
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Entity Type | Organization
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Legal Business Name | TAMMY J. PENHOLLOW, DO, PC
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 2000 VAN NESS AVE SUITE 402
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-3023
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Country | US
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Telephone | 415-567-1219
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 VAN NESS AVE SUITE 402
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-3023
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Country | US
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Telephone | 415-567-1219
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TAMMY JOLENE PENHOLLOW
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Credential | D.O.
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Telephone | 415-567-1219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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