Provider Demographics
NPI:1629355227
Name:PENARANDA, HILARIO GO III (RPT)
Entity Type:Individual
Prefix:MR
First Name:HILARIO
Middle Name:GO
Last Name:PENARANDA
Suffix:III
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 GONZALEZ DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-2233
Mailing Address - Country:US
Mailing Address - Phone:818-395-3097
Mailing Address - Fax:
Practice Address - Street 1:737 GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-2233
Practice Address - Country:US
Practice Address - Phone:818-395-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-27496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist