Provider Demographics
NPI:1619344710
Name:PENAMON, BRITTNEY (RDHAP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:PENAMON
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 W SLAUSON AVE
Mailing Address - Street 2:STE #135
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1290
Mailing Address - Country:US
Mailing Address - Phone:323-998-3001
Mailing Address - Fax:
Practice Address - Street 1:3800 STOCKER ST
Practice Address - Street 2:23
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008-5122
Practice Address - Country:US
Practice Address - Phone:323-998-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAOtherMEDICAL