Provider Demographics
NPI:1740333657
Name:PENALVA, JOSE A (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:PENALVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4926
Mailing Address - Country:US
Mailing Address - Phone:760-745-2905
Mailing Address - Fax:760-745-4270
Practice Address - Street 1:421 S JUNIPER ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4926
Practice Address - Country:US
Practice Address - Phone:760-745-2905
Practice Address - Fax:760-745-4270
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice