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NPI Code Detail

MEDICARE: LENNY ROSE PANGUE SMITH

MEDICARE: LENNY ROSE PANGUE SMITH
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
1172V00000XCommunity Health Worker
2390200000XStudent in an Organized Health Care Education/Training Program
3373H00000XDay Training/Habilitation Specialist
4225400000XRehabilitation PractitionerCA

General Provider Information

NPI Number : 1982332862
Entity Type Code : Individual
Provider Name (Legal Business Name) : LENNY ROSE PANGUE SMITH
Provider Business Mailing Address
First Line : 409 JACKSON ST
Second Line :
City : HAYWARD
State : CA
Zip : 94544-1530
Country : US
Telephone Number : 510-891-5642
Fax Number :
Provider Business Practice Location Address
First Line : 409 JACKSON ST
Second Line :
City : HAYWARD
State : CA
Zip : 94544-1530
Country : US
Telephone Number : 510-891-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2022
Last Update Date : 03/05/2026

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Directions to “ LENNY ROSE PANGUE SMITH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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