MEDICARE: PENNISI MEDICAL GROUP

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043172760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNISI MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1805 N CALIFORNIA ST STE 406
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6033
Country	:	US
Telephone Number	:	209-277-7806
Fax Number	:	209-851-3853

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 406
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6033
Country	:	US
Telephone Number	:	209-277-7806
Fax Number	:	209-851-3853

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DOMINIC PENNISI
Credential	:	MD
Telephone Number	:	209-277-7806

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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