Healthcare Provider Details

I. General information

NPI: 1972807345
Provider Name (Legal Business Name): DAVID PENA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W HERNDON AVE STE 102
CLOVIS CA
93612-0381
US

IV. Provider business mailing address

255 W HERNDON AVE STE 102
CLOVIS CA
93612-0381
US

V. Phone/Fax

Practice location:
  • Phone: 559-550-6226
  • Fax: 559-550-6262
Mailing address:
  • Phone: 559-550-6226
  • Fax: 559-550-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number21099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: