Individual
GLORIA JUDITH PENATE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2103 NORTH DIVISION STREET, TACOMA, WA 98433
(253) 967-3416
(253) 966-7848
Mailing address
MADIGAN ANNEX 9900, TACOMA, WA 98431-0001
(253) 968-4944
(253) 968-4900
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
22724
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22724
DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
FL
Enumeration date
05/08/2018
Last updated
05/08/2018
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