Provider Demographics
NPI:1831270362
Name:PENUNURI, RAFAEL ARTURO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ARTURO
Last Name:PENUNURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 SUPERIOR AVE
Mailing Address - Street 2:STE#1
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-650-0587
Mailing Address - Fax:949-631-8155
Practice Address - Street 1:1419 SUPERIOR AVE
Practice Address - Street 2:STE#1
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2723
Practice Address - Country:US
Practice Address - Phone:949-650-0587
Practice Address - Fax:949-631-8155
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93001Medicare UPIN