Individual
DR. CORBETT LEE PENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 ATLANTIC AVE, LONG BEACH, CA 90806-1701
(562) 933-2000
(562) 933-1245
Mailing address
PO BOX 10429, NEWPORT BEACH, CA 92658-0429
(949) 417-1812
(949) 417-1803
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G21858
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G218580
BLUE SHIELD ID #
CA
05
—
00G218580
—
CA
01
—
00G218580385
CALOPTIMA ID #
CA
Enumeration date
07/20/2006
Last updated
07/09/2007
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