| Penny Lane | |
|
190 Sierra Ct Palmdale CA 93550-7607 | |
| (661) 272-4883 | |
| (661) 272-1005 |
| Full Name | Penny Lane |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 190 Sierra Ct, Palmdale, California |
| Authorized Official Name and Position | Marcus Marquis Nelson (CFS) |
| Authorized Official Contact | 6612724883 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Penny Lane 190 Sierra Ct Palmdale CA 93550-7607 Ph: (661) 272-4883 | Penny Lane 190 Sierra Ct Palmdale CA 93550-7607 Ph: (661) 272-4883 |
| NPI Number | 1699906198 |
|---|---|
| Provider Enumeration Date | 07/31/2009 |
| Last Update Date | 07/31/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699906198 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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