Healthcare Provider Details

I. General information

NPI: 1154605723
Provider Name (Legal Business Name): RUBEN PENA JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 QUILL DR
DOWNEY CA
90242-2001
US

IV. Provider business mailing address

7285 QUILL DR
DOWNEY CA
90242-2001
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-8826
  • Fax: 562-381-8538
Mailing address:
  • Phone: 323-226-8826
  • Fax: 562-381-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: