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General NPI Number Information
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NPI Number | 1396182333
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Entity Type | Individual
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Provider Name | JANINE ELIZABETH PENHA RD, CDE
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Gender | Female
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 2550 SAMARITAN DR SUITE A
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City | SAN JOSE
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State | CA
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Zip | 95124-4104
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Country | US
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Telephone | 707-337-2163
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Fax |
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Provider Business Mailing Address
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Address Line | 10645 CALLE MAR DE MARIPOSA APT 6113
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City | SAN DIEGO
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State | CA
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Zip | 92130-8718
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Country | US
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Telephone | 707-337-2163
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 21220047
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 910306
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License Number State | FL
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