MEDICARE: DR. BRAD LESLIE PENENBERG M.D.

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	207X00000X	Orthopaedic Surgery Physician	G058794	CA

General Provider Information

NPI Number	:	1831122266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD LESLIE PENENBERG M.D.

Provider Business Mailing Address
First Line	:	120 S SPALDING DR STE 400
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1842
Country	:	US
Telephone Number	:	310-860-3470
Fax Number	:	310-860-3448

Provider Business Practice Location Address
First Line	:	120 S SPALDING DR STE 400
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1842
Country	:	US
Telephone Number	:	310-860-3470
Fax Number	:	310-860-3448

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/03/2015

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Directions to “ DR. BRAD LESLIE PENENBERG M.D.” Practice Location

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