Healthcare Provider Details

I. General information

NPI: 1053244889
Provider Name (Legal Business Name): DAVID DELA PENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR
FOLSOM CA
95630-4788
US

IV. Provider business mailing address

3398 RIDGE POINTE RD
CHINO HILLS CA
91709-1430
US

V. Phone/Fax

Practice location:
  • Phone: 877-272-5818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: