Provider Demographics
NPI:1982469870
Name:PENNIX, ROMAN
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:PENNIX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 LINCOLN AVE STE 20-1008
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3110
Mailing Address - Country:US
Mailing Address - Phone:408-900-2818
Mailing Address - Fax:
Practice Address - Street 1:1060 LINCOLN AVE STE 20-1008
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3110
Practice Address - Country:US
Practice Address - Phone:408-900-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)