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NPI Code Detail

MEDICARE: KATHERINE RAE PENNINGA

MEDICARE: KATHERINE RAE PENNINGA
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
1104100000XSocial Worker6801093772MI
2104100000XSocial Worker90390CA

General Provider Information

NPI Number : 1649546979
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE RAE PENNINGA
Provider Business Mailing Address
First Line : 1601 PRECISION PARK LN
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-1345
Country : US
Telephone Number : 619-662-4100
Fax Number :
Provider Business Practice Location Address
First Line : 1601 PRECISION PARK LN
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-1345
Country : US
Telephone Number : 619-662-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2012
Last Update Date : 07/01/2024

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Directions to “ KATHERINE RAE PENNINGA ” Practice Location

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