Provider Demographics
NPI:1831186501
Name:PENNINGTON, GENA CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:GENA
Middle Name:CHRISTINE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2773 HARRIS ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4866
Mailing Address - Country:US
Mailing Address - Phone:707-445-1600
Mailing Address - Fax:707-445-3778
Practice Address - Street 1:2773 HARRIS ST
Practice Address - Street 2:SUITE F
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4866
Practice Address - Country:US
Practice Address - Phone:707-445-1600
Practice Address - Fax:707-445-3778
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2012-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC34152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC34152OtherCALIFORNIA LICENSE
A35519Medicare UPIN