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General NPI Number Information
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NPI Number | 1346077567
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Entity Type | Individual
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Provider Name | MICHAEL PAUL PENNA RN
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Gender | Male
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 13661 CALIMESA BLVD STE 6
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City | YUCAIPA
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State | CA
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Zip | 92399-2370
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Country | US
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Telephone | 909-699-2539
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Fax |
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Provider Business Mailing Address
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Address Line | 13661 CALIMESA BLVD STE 6
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City | YUCAIPA
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State | CA
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Zip | 92399-2370
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Country | US
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Telephone | 909-699-2539
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | P30227
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 95170352
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License Number State | CA
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