Individual
JACQUELINE PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O..
Contact information
Practice address
1001 POTRERO AVE # 6B, SAN FRANCISCO, CA 94110
(415) 206-5270
(415) 206-4722
Mailing address
4802 10TH AVENUE, MAIMONIDES MEDICAL CENTER, BROOKLYN, NY 11219
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
20A16297
CA
390200000X
Student in an Organized Health Care Education/Training Program
196488853
NY
Other
Enumeration date
04/16/2015
Last updated
06/07/2018
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