Healthcare Provider Details

I. General information

NPI: 1124860085
Provider Name (Legal Business Name): JULIA CHRISTINE PENADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 CENTER COVINA DRIVE SUITE 211
COVINA CA
91724
US

IV. Provider business mailing address

1274 CENTER COVINA DRIVE SUITE 211
COVINA CA
91724
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-4999
  • Fax:
Mailing address:
  • Phone: 626-339-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: