Provider Demographics
NPI:1154344927
Name:PENTSCHEV, STEFAN I (MD)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:I
Last Name:PENTSCHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1838
Mailing Address - Country:US
Mailing Address - Phone:559-592-2134
Mailing Address - Fax:559-592-5017
Practice Address - Street 1:330 E PINE ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1838
Practice Address - Country:US
Practice Address - Phone:559-592-2134
Practice Address - Fax:559-592-5017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438930Medicaid
CA00A438930Medicaid
CAA29751Medicare UPIN