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General NPI Number Information
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NPI Number | 1437152907
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Entity Type | Individual
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Provider Name | JAY PENNOCK MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1595 38TH AVE
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City | CAPITOLA
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State | CA
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Zip | 95010-2901
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Country | US
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Telephone | 831-226-2108
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Fax | 888-258-3926
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Provider Business Mailing Address
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Address Line | 1840 41ST AVE # 102-325
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City | CAPITOLA
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State | CA
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Zip | 95010-2513
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Country | US
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Telephone | 831-345-0652
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Fax | 888-258-3926
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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 | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number | G77385
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License Number State | CA
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