| Stefan Pentschev Md Medical Corporation | |
|
30926 E Kings Canyon Rd Squaw Valley CA 93675-9601 | |
| (559) 332-1112 | |
| (559) 332-1112 |
| Full Name | Stefan Pentschev Md Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 30926 E Kings Canyon Rd, Squaw Valley, California |
| Authorized Official Name and Position | Stefan I Pentschev, (OWNER & PHYSICIAN) |
| Authorized Official Contact | 5593321112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stefan Pentschev Md Medical Corporation 30926 E Kings Canyon Rd Squaw Valley CA 93675-9601 Ph: (559) 332-1112 | Stefan Pentschev Md Medical Corporation 30926 E Kings Canyon Rd Squaw Valley CA 93675-9601 Ph: (559) 332-1112 |
| NPI Number | 1003639808 |
|---|---|
| Provider Enumeration Date | 11/01/2024 |
| Last Update Date | 11/01/2024 |
| Medicare PECOS PAC ID | 1850828740 |
|---|---|
| Medicare Enrollment ID | O20241216004030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003639808 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stefan Pentschev |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1154344927 PECOS PAC ID: 7810807161 Enrollment ID: I20080717000462 |
San Joaquin Prime Care Medical Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 30924 E Kings Canyon Rd, Squaw Valley, CA 93675 Phone: 559-332-9399 Fax: 559-332-9499 |