Provider Demographics
NPI:1215175070
Name:PENN, JULIET M (MD)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:M
Last Name:PENN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 W QUINTO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5318
Practice Address - Country:US
Practice Address - Phone:805-563-0041
Practice Address - Fax:805-563-0051
Is Sole Proprietor?:No
Enumeration Date:2009-01-31
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105540207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1055400OtherBLUE SHIELD
CAP01061463OtherRAILROAD MEDICARE
CA4912531OtherCIGNA
CA1215175070Medicaid
CAGE068ZMedicare PIN