NPIMap

Organization Active NPI

Penny R. Vandestreek DO, Inc.

  • Nuclear Imaging & Therapy Physician
  • Roseville, CA
National Provider Identifier
1558540526
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Imaging & Therapy PhysicianTaxonomy code 207UN0902X
License
20A6232 Issued in CA
Legal business name
PENNY R. VANDESTREEK DO, INC.
Practice address
1 Medical Plaza Dr
Att Nuclear Medicine
Roseville, CA 95661-3037
Phone
(916) 781-1292
Fax
(916) 663-9912
NPI assigned
Oct 26, 2007
Last updated
Jun 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

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

Authorized official

Name
Penny R Vandestreek, DONPI 1164463402
Title
President
Phone
(916) 781-1292

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Imaging & Therapy PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207UN0902X 20A6232 CA Primary

Addresses

Primary practice location

1 Medical Plaza Dr
Att Nuclear Medicine
Roseville, CA 95661-3037

Mailing address

PO Box 1328
Rocklin, CA 95677-7328
Phone (916) 781-1292

Other identifiers 2

IdentifierTypeStateIssuer
00AX62320MedicaidCA
P00017739OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

2 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

1 Medical Plaza Dr
#A
Roseville, CA 95661
Phone (916) 791-1292

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1558540526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1328",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "956777328",
            "telephone_number": "916-781-1292",
            "fax_number": "916-663-9912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PLAZA DR",
            "address_2": "ATT NUCLEAR MEDICINE",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613037",
            "telephone_number": "916-781-1292",
            "fax_number": "916-663-9912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNY R. VANDESTREEK DO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-26",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "VANDESTREEK",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-781-1292",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207UN0902X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "CA",
            "license": "20A6232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX62320",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00017739",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.