Active NPI
Deborah B Penrose, DO
- Family Medicine Physician
- Half Moon Bay, CA
National Provider Identifier
1710019187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A4678
- Practice address
- 725 Main Street
Half Moon Bay, CA 94019 - Phone
- (650) 726-1200
- Fax
- (650) 726-1235
- NPI assigned
- Mar 12, 2007
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A4678 | CA | Primary |
Addresses
Primary practice location
725 Main Street
Half Moon Bay, CA 94019
Mailing address
725 Main St
Half Moon Bay, CA 94019
Phone (650) 726-1200
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A4678 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710019187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 MAIN ST",
"city": "HALF MOON BAY",
"state": "CA",
"postal_code": "94019",
"telephone_number": "650-726-1200",
"fax_number": "650-726-1235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 MAIN STREET",
"city": "HALF MOON BAY",
"state": "CA",
"postal_code": "94019",
"telephone_number": "650-726-1200",
"fax_number": "650-726-1235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENROSE",
"first_name": "DEBORAH",
"middle_name": "B",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A4678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Half Moon Bay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.