Provider Demographics
NPI:1962530394
Name:KNAPP, PENELOPE K (MD)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:K
Last Name:KNAPP
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 1:22657 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:MONTE RIO
Mailing Address - State:CA
Mailing Address - Zip Code:95462-9797
Mailing Address - Country:US
Mailing Address - Phone:916-799-5341
Mailing Address - Fax:707-922-0078
Practice Address - Street 1:1600 9TH ST
Practice Address - Street 2:SUITE 151
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-6404
Practice Address - Country:US
Practice Address - Phone:916-654-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG493842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMS200014Medicare ID - Type UnspecifiedCHILDREN'S MEDICAL SERVIC