Provider Demographics
NPI:1295979870
Name:PENNA, IGNEZ JANSEN (MD)
Entity type:Individual
Prefix:DR
First Name:IGNEZ
Middle Name:JANSEN
Last Name:PENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IGNEZ
Other - Middle Name:JANSEN
Other - Last Name:PENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4316 MARINA CITY DR UNIT 1031
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5820
Mailing Address - Country:US
Mailing Address - Phone:310-823-1230
Mailing Address - Fax:
Practice Address - Street 1:4316 MARINA DEL REY DRIVE
Practice Address - Street 2:# 1031
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:310-823-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC535662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry