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NPI Code Detail

MEDICARE: STEPHEN T. PENEPACKER MD

MEDICARE: STEPHEN T. PENEPACKER MD
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
12084P0800XPsychiatry PhysicianC180768CA

General Provider Information

NPI Number : 1336165125
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN T. PENEPACKER MD
Provider Business Mailing Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-781-4700
Fax Number : 805-781-1232
Provider Business Practice Location Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-781-4700
Fax Number : 805-781-1232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 12/09/2025

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Directions to “ STEPHEN T. PENEPACKER MD” Practice Location

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