Individual
MARIA TINA PENALOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6333 CENTER DR BLDG 16, NORFOLK, VA 23502-4126
(757) 252-9500
(757) 962-9801
Mailing address
6333 CENTER DR BLDG 16, NORFOLK, VA 23502-4126
(757) 252-9500
(757) 962-9801
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001786
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10004736P
SENTARA OPTIMA
—
01
—
10245036
MEDICAID FIRST HEALTH
—
01
—
541870984006
CHAMPUS
—
01
—
C13214
MEDICARE RR GROUP
—
01
—
P00271162
TRAVELERS RR MEDICARE
—
Enumeration date
03/22/2006
Last updated
03/02/2022
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