Healthcare Provider Details

I. General information

NPI: 1366464901
Provider Name (Legal Business Name): KYOKO CHIEMI PENA-ROBLES MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYOKO CHIEMI PENA

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7526 MONTEREY ST GARDNER HEALTH CENTER-GILORY
GILROY CA
95020-5826
US

IV. Provider business mailing address

7524 MONTEREY ST.
GILROY CA
95020
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-9400
  • Fax: 408-848-9464
Mailing address:
  • Phone: 408-848-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA92545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: