Provider Demographics
NPI:1821358052
Name:PENKOVA, KATERINA (LAC)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:PENKOVA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 COMMODITY CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9052
Mailing Address - Country:US
Mailing Address - Phone:407-704-7878
Mailing Address - Fax:407-704-7986
Practice Address - Street 1:8809 COMMODITY CIR STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9052
Practice Address - Country:US
Practice Address - Phone:407-704-7878
Practice Address - Fax:407-704-7986
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist