MARY ROSALIE PENA-PRIDMORE (NPI# 1336240837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336240837 |
| Entity Type | Individual |
| Full Name | MARY ROSALIE PENA-PRIDMORE |
| Other Name | MARY ROSALIE PENA-PRIDMORE |
| Credential | MD |
| Practice Address |
9980 Live Oak Blvd Live Oak CA 95953-2334 |
| Mailing Address |
1114 Yuba St Rm 144 Marysville CA 95901-4838 |
| Practice Telephone | 5307493242 |
| Practice Fax Number | 5307493248 |
| Mailing Telephone | 5307493242 |
| Mailing Fax Number | 5307419274 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2018-11-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 51623 | CA | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | C51623 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | EXE70043F | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 724 5th St, Marysville, CA 959015646 | 5307437413 | 5307437971 |
| Street Address |
9980 LIVE OAK BLVD |
| City | LIVE OAK |
| State | CA |
| Zip Code | 95953-2334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447243811 | Tomas Wong Wy | Family Medicine | 9980 Live Oak Blvd, Live Oak, CA 95953-2334 | 2005-08-31 |
| 1982186508 | Hardeep Mundh | Nurse Practitioner | 9980 Live Oak Blvd, Live Oak, CA 95953 | 2018-08-30 |
| 1134470636 | Baljit Sohal | Optometrist | 9980 Live Oak Blvd, Live Oak, CA 95953-2334 | 2012-09-24 |
| 1316096894 | Peach Tree Healthcare | Optometrist | 9980 Live Oak Blvd, Live Oak, CA 95953-2334 | 2007-01-10 |
| 1972676922 | Andrea Bonnenfant | Physician Assistant | 9980 Live Oak Blvd, Live Oak, CA 95953-2334 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710995840 | Western Physical Therapy, Inc. | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2006-08-04 |
| 1275141582 | Angela Elizabeth Heintz | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2020-07-22 |
| 1639704885 | Snehaben Joshi | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2020-03-09 |
| 1801326848 | Kathryn Eleanor Hickey | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2017-06-13 |
| 1831598762 | Samuel Lewis Iqbal-hofmeister | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2014-08-15 |
| 1639516099 | Caleb Andrew Collier | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2013-05-25 |
| 1679683338 | Lisa M Boyan | Physical Therapist | 10255 Live Oak Blvd, Live Oak, CA 95953-2015 | 2006-08-30 |
| 1740772243 | Guadalupe Cecilia Hernandez | Behavior Technician | 10083 N St, Live Oak, CA 95953-2025 | 2018-05-31 |
| 1265692040 | Guardian Angel Transportation | Non-emergency Medical Transport (VAN) | 3014 Forstner Ct, Live Oak, CA 95953-2046 | 2008-06-14 |
| 1730683988 | Wendy Ruby Ibarra Diaz | Behavior Technician | 10235 Larkin Rd Spc 4, Live Oak, CA 95953-2141 | 2018-03-22 |
| Find all providers in zip 95953 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215110192 | Renaldas Algirdas Smidtas | Family Medicine | 1437 N Ohio Ave, Live Oak, FL 32064-4817 | 2007-12-13 |
| 1871789867 | Toepperwein Family Practice, Pa | Family Medicine | 11355 Toepperwein Rd, Live Oak, TX 78233-3230 | 2007-09-24 |
| 1215022421 | Moiz Abbas Tajkhanji | Family Medicine | 11355 Toepperweinroad, Live Oak, TX 78233 | 2006-10-04 |
| 1568405728 | Eduardo Gustavo Romero | Family Medicine | 1304 Ohio Ave S, Live Oak, FL 32064-4156 | 2006-06-14 |
| 1902874233 | James C Razi | Family Medicine | 211 Ranchera St Nw, Live Oak, FL 32064-4866 | 2006-03-11 |
| 1073593737 | Beverly Ann Heinking | Family Medicine | 300 Pinewood Dr Sw, Live Oak, FL 32064-4029 | 2006-01-19 |
| 1174921696 | Live Oak Hma, LLC | Family Medicine | 1426 Canyon Ave Ne, Unit B, Live Oak, FL 32064-4832 | 2014-12-16 |
| 1659506285 | Chelo Belmonte | Family Medicine | 12602 Toepperwein Rd, Suite #100, Live Oak, TX 78233-3269 | 2009-05-27 |
| 1598904732 | Eduardo G Romero Md Pa Inc | Family Medicine | 1304 Ohio Ave S, Live Oak, FL 32064-4156 | 2009-02-11 |
| 1346488905 | Victor G Rosales | Family Medicine | 12602 Toepperwein Rd, Suite 100, Live Oak, TX 78233-3269 | 2009-02-04 |
| Find all providers in LIVE OAK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.