Provider Demographics
NPI:1821980244
Name:PENREE, GEORGE MELVIN IV (RAD-T)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MELVIN
Last Name:PENREE
Suffix:IV
Gender:M
Credentials:RAD-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ROCKAWAY RD
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022-9306
Mailing Address - Country:US
Mailing Address - Phone:805-273-8798
Mailing Address - Fax:
Practice Address - Street 1:158 ROCKAWAY RD
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9306
Practice Address - Country:US
Practice Address - Phone:805-273-8798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1621000725106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician