MEDICARE: DR. PENELOPE J HANKIN PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY13737	CA

General Provider Information

NPI Number	:	1033369814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENELOPE J HANKIN PSYD

Provider Business Mailing Address
First Line	:	2275 W 25TH ST
Second Line	:	#100
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-4901
Country	:	US
Telephone Number	:	310-519-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 MORENA BLVD
Second Line	:	STE. 109
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3423
Country	:	US
Telephone Number	:	858-272-3992
Fax Number	:	858-272-3804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

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