Provider Demographics
NPI:1861486813
Name:ABLIN, PENNY HEATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:HEATHER
Last Name:ABLIN
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:PO BOX 4685
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-1685
Mailing Address - Country:US
Mailing Address - Phone:209-536-3460
Mailing Address - Fax:209-536-5305
Practice Address - Street 1:1000 GREENLEY RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5200
Practice Address - Country:US
Practice Address - Phone:209-536-3460
Practice Address - Fax:209-536-3505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-09
Deactivation Date:2005-09-06
Deactivation Code:
Reactivation Date:2006-02-03
Provider Licenses
StateLicense IDTaxonomies
CAG40240207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48156Medicare UPIN