Provider Demographics
NPI:1336601426
Name:PENHA, ANDERSON DA PAZ (MD, MAS)
Entity type:Individual
Prefix:DR
First Name:ANDERSON
Middle Name:DA PAZ
Last Name:PENHA
Suffix:
Gender:M
Credentials:MD, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LENORA STREET, PMB 1209
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121
Mailing Address - Country:US
Mailing Address - Phone:619-770-7250
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVENUE
Practice Address - Street 2:SUITE 17-240 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program