Active NPI
Gloria Judith Penate I
- Dental Hygienist
- Tacoma, WA
National Provider Identifier
1205325966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 22724
- Practice address
- 2103 North Division Street
Tacoma, WA 98433 - Phone
- (253) 967-3416
- Fax
- (253) 966-7848
- NPI assigned
- May 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 22724 | FL | Primary |
Addresses
Primary practice location
2103 North Division Street
Tacoma, WA 98433
Mailing address
Madigan Annex 9900
Tacoma, WA 98431-0001
Phone (253) 968-4944
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22724 | Other | FL | DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22724 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525737600000",
"number": "1205325966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MADIGAN ANNEX 9900",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "253-968-4944",
"fax_number": "253-968-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2103 NORTH DIVISION STREET",
"city": "TACOMA",
"state": "WA",
"postal_code": "98433",
"telephone_number": "253-967-3416",
"fax_number": "253-966-7848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENATE",
"first_name": "GLORIA",
"middle_name": "JUDITH",
"name_suffix": "I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-08",
"last_updated": "2018-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "22724",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE",
"identifier": "22724",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.