National Provider Identifier Database

PENNY R VANDESTREEK DO INC
Nuclear Imaging & Therapy


Contact Information

PENNY R. VANDESTREEK DO, INC.
1 MEDICAL PLAZA DR
ATT NUCLEAR MEDICINE
ROSEVILLE, CA95661-3037
Phone: 916-781-1292
Fax: 916-663-9912
Website:
Specialty Taxonomy Code
* Nuclear Imaging & Therapy 207UN0902X

* Indicates primary specialty

NPI Profile & details for PENNY R. VANDESTREEK DO, INC.

NPI Number 1558540526
Legal business name
LBN
PENNY R. VANDESTREEK DO, INC.
Authorized official PENNY VANDESTREEK - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 10/26/2007
Last updated 06/30/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • CA License #: 20A6232
  • CA Medicaid: 00AX62320
  • Other: P00017739 RAILROAD MEDICARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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