Individual
DR. ELENI PENTHEROUDAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, EMERGENCY DEPARTMENT, LA MESA, CA 91942-3019
(619) 740-4402
Mailing address
5555 GROSSMONT CENTER DR, EMERGENCY DEPARTMENT, LA MESA, CA 91942-3019
(619) 740-4402
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A75191
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001899576
—
PA
05
—
00A751910
—
CA
Enumeration date
06/03/2006
Last updated
02/18/2014
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