MEDICARE: LEILA MAE PENASALES FNP-C

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	363L00000X	Nurse Practitioner	95008231	CA

General Provider Information

NPI Number	:	1528567542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA MAE PENASALES FNP-C

Provider Business Mailing Address
First Line	:	2036 NOWELL AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3829
Country	:	US
Telephone Number	:	626-675-3470
Fax Number	:

Provider Business Practice Location Address
First Line	:	2036 NOWELL AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3829
Country	:	US
Telephone Number	:	626-675-3470
Fax Number	:

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

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/11/2021

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