MEDICARE: JAY PENNOCK MEDICAL DIRECTOR PC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1821881830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY PENNOCK MEDICAL DIRECTOR PC

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	:	901 SOQUEL AVE STE A
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2122
Country	:	US
Telephone Number	:	831-345-0652
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	JAY PENNOCK
Credential	:	MD
Telephone Number	:	831-345-0652

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	05/23/2025

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