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General NPI Number Information
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NPI Number | 1487653341
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Entity Type | Individual
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Provider Name | VINCENT P PENNISI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 1617 N CALIFORNIA ST. SUITE 2-A
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City | STOCKTON
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State | CA
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Zip | 95204
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Country | US
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Telephone | 209-466-8546
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Fax | 209-466-3335
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | LODI
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State | CA
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Zip | 95241-1090
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Country | US
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Telephone | 209-334-1800
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Fax | 209-334-1430
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G45259
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G45259
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License Number State | CA
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