Provider Demographics
NPI:1003639808
Name:STEFAN PENTSCHEV MD MEDICAL CORPORATION
Entity type:Organization
Organization Name:STEFAN PENTSCHEV MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:PENTSCHEV,
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-332-1112
Mailing Address - Street 1:30926 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SQUAW VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93675-9601
Mailing Address - Country:US
Mailing Address - Phone:559-332-1112
Mailing Address - Fax:
Practice Address - Street 1:30926 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:SQUAW VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93675-9601
Practice Address - Country:US
Practice Address - Phone:559-332-1112
Practice Address - Fax:559-332-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty