Basic Information
| Provider Information | |||||||||
| NPI: | 1861486813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABLIN | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | HEATHER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4685 | ||||||||
| Address2: | |||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953701685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095363460 | ||||||||
| FaxNumber: | 2095365305 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 GREENLEY RD | ||||||||
| Address2: | |||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953705200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095363460 | ||||||||
| FaxNumber: | 2095363505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 09/06/2005 | ||||||||
| NPIReactivationDate: | 02/03/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G40240 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.