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General NPI Number Information
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NPI Number | 1639480247
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Entity Type | Individual
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Provider Name | MANEESH SURESH PENKAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 3701 SKYPARK DR STE 105
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City | TORRANCE
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State | CA
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Zip | 90505-4712
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Country | US
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Telephone | 310-373-1400
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Fax | 310-791-7977
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Provider Business Mailing Address
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Address Line | 23560 MADISON ST STE 204
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City | TORRANCE
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State | CA
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Zip | 90505-4710
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Country | US
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Telephone | 424-328-0203
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Fax | 424-328-0204
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LL32972
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2013-01695
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C167686
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License Number State | CA
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