Broadway, Penny Jo
Broadway, Penny Jo is an sole proprietor health care provider with primary practice located at 1529 E Palmdale Blvd Suite 210, Palmdale CA 93550-2034. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Broadway, Penny Jo can be contacted via phone (661) 272-9996.Contact Information
Primary practice address
1529 E Palmdale Blvd Suite 210
Palmdale CA 93550-2034
Phone: (661) 272-9996
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X |
Profile Details
| NPI number | 1922201797 |
|---|---|
| LBN Legal business name | Broadway, Penny Jo |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 7th, 2007 |
| Last updated | Dec 30th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922201797 | NPPES |
| California | MEDICAID | 00007301A |
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