Provider Demographics
NPI:1821293747
Name:PENAROZA, SHYLA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHYLA
Middle Name:MICHELLE
Last Name:PENAROZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2208
Mailing Address - Country:US
Mailing Address - Phone:808-387-8281
Mailing Address - Fax:
Practice Address - Street 1:921 NE 13TH STREET
Practice Address - Street 2:VAMC OKLAHOMA CITY
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-456-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK256852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology