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General NPI Number Information
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NPI Number | 1902779226
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Entity Type | Individual
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Provider Name | PENNY DORFMAN
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Gender |
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 1100 SAN LEANDRO BLVD FL 3
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1595
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Country | US
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Telephone | 510-267-3250
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Fax |
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Provider Business Mailing Address
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Address Line | 3951 BEECHWOOD DR
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City | CONCORD
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State | CA
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Zip | 94519-1239
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Country | US
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Telephone | 925-360-9229
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 532010
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License Number State | CA
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