Provider Demographics
NPI:1346391455
Name:UNDERWOOD, PENELOPE GUTHRIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:GUTHRIE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39664 MAPLE LEAF CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5303
Mailing Address - Country:US
Mailing Address - Phone:714-679-8993
Mailing Address - Fax:
Practice Address - Street 1:28362 VINCENT MORAGA DR STE D
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3655
Practice Address - Country:US
Practice Address - Phone:951-395-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist