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General NPI Number Information
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NPI Number | 1487032371
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Entity Type | Individual
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Provider Name | JUDY J PENG
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Gender | Female
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 6862 GLORIA DR
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City | SACRAMENTO
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State | CA
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Zip | 95831-2440
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Country | US
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Telephone | 916-929-2598
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Fax | 916-970-5278
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Provider Business Mailing Address
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Address Line | 6862 GLORIA DR
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City | SACRAMENTO
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State | CA
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Zip | 95831-2440
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Country | US
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Telephone | 916-929-2598
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Fax | 916-970-5278
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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