MEDICARE: MARIA FERNANDA PENUNURI DPT

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	2251C2600X	Cardiopulmonary Physical Therapist
2	2251G0304X	Geriatric Physical Therapist
3	2251N0400X	Neurology Physical Therapist
4	2251X0800X	Orthopedic Physical Therapist
5	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	PT294447	CA

General Provider Information

NPI Number	:	1033602016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA FERNANDA PENUNURI DPT

Provider Business Mailing Address
First Line	:	2127 OLYMPIC PKWY # 1006-602
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1359
Country	:	US
Telephone Number	:	619-306-1744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2694 ESCALA CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-6720
Country	:	US
Telephone Number	:	619-306-1744
Fax Number	:

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

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	07/07/2020

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