MEDICARE: CRISTEL PENTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1255120879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTEL PENTON

Provider Business Mailing Address
First Line	:	495 VALLEY RD
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-3900
Country	:	US
Telephone Number	:	805-474-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	495 VALLEY RD
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-3900
Country	:	US
Telephone Number	:	805-474-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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Directions to “ CRISTEL PENTON ” Practice Location

Language	Start Address	Practice Location

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