Emelyn Bernardo Penaloza, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA10004 Issued in CA

Practice address

800 S Ham LN
Lodi, CA 95242-3543

Phone

(209) 368-7141

NPI assigned

Aug 26, 2017

Last updated

Aug 26, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503705600000",
    "number": "1316464761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8887 SERRAVILLA WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957586338",
            "telephone_number": "989-254-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S HAM LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423543",
            "telephone_number": "209-368-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENALOZA",
        "first_name": "EMELYN",
        "middle_name": "BERNARDO",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-26",
        "last_updated": "2017-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "PTA10004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daryl B Payne, D.D.S.
• Lance Peery, D.D.S.
• Milly A Pekke, RN
• Petwa Pekke
• Victoria Pelayo
• Dominic Pennisi, M.D.
• Natharchia R Peoples
• Christa Pera, LMFT
• Betsy Pereida
• Christopher Perez

• Physical Therapy Assistant in Lodi, CA
• Providers in Lodi, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.