Healthcare Provider Details

I. General information

NPI: 1902712466
Provider Name (Legal Business Name): INNOVATIVE PHYSICAL THERAPY INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 MALIBU CANYON RD
BREA CA
92821-2641
US

IV. Provider business mailing address

972 MALIBU CANYON RD
BREA CA
92821-2641
US

V. Phone/Fax

Practice location:
  • Phone: 562-303-6366
  • Fax:
Mailing address:
  • Phone: 562-303-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS PENA PINEDA III
Title or Position: CEO
Credential: DPT
Phone: 562-303-6366