MEDICARE: VALERIA ANA PENELA A PSYCHOLOGICAL CORPORATION

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	103T00000X	Psychologist	PSY20934	CA

General Provider Information

NPI Number	:	1356675722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALERIA ANA PENELA A PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	1334 WESTWOOD BLVD STE 2B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4951
Country	:	US
Telephone Number	:	310-623-7681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 WESTWOOD BLVD STE 2B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4951
Country	:	US
Telephone Number	:	310-623-7681
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. VALERIA ANA PENELA
Credential	:	PSY.D
Telephone Number	:	310-623-7681

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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