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General NPI Number Information
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NPI Number | 1326128158
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Entity Type | Organization
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Legal Business Name | MAINSTREET MEDICAL PRACTICE
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 725 MAIN STREET
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City | HALF MOON BAY
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State | CA
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Zip | 94019
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Country | US
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Telephone | 650-726-1200
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Fax | 650-726-1235
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Provider Business Mailing Address
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Address Line | 725 MAIN STREET
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City | HALF MOON BAY
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State | CA
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Zip | 94019
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Country | US
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Telephone | 650-726-1200
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Fax | 650-726-1235
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DEBORAH B PENROSE
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Credential | DO
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Telephone | 650-726-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A4678
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License Number State | CA
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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 | G31635
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A62160
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License Number State | CA
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