MEDICARE: JAY PENNOCK 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
1	202D00000X	Integrative Medicine Physician	G77385	CA

General Provider Information

NPI Number	:	1437152907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY PENNOCK MD

Provider Business Mailing Address
First Line	:	1840 41ST AVE # 102-325
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2513
Country	:	US
Telephone Number	:	831-345-0652
Fax Number	:	888-258-3926

Provider Business Practice Location Address
First Line	:	1595 38TH AVE
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2901
Country	:	US
Telephone Number	:	831-226-2108
Fax Number	:	888-258-3926

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/10/2025

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Directions to “ JAY PENNOCK MD” Practice Location

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