Individual
BRIAN SCOTT PENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1551 BISHOP ST BLDG A STE 110, SAN LUIS OBISPO, CA 93401-4692
(805) 548-8585
(805) 548-8589
Mailing address
1551 BISHOP ST BLDG A STE 110, SAN LUIS OBISPO, CA 93401-4692
(805) 548-8585
(805) 548-8589
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A84188
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A841880
—
CA
01
—
A84188
NHIC- MEDICARE INDV PROVIDER NUMBER
CA
01
—
BV188Z
MEDICARE INDV PTAN NUMBER- PALMETTO GBA
CA
Enumeration date
05/23/2006
Last updated
11/03/2023
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