Healthcare Provider Details

I. General information

NPI: 1952216046
Provider Name (Legal Business Name): LORENZO V PENA PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 MAIN ST
HUNTINGTON BEACH CA
92648-2705
US

IV. Provider business mailing address

32895 CIELO VISTA RD APT 1
CATHEDRAL CITY CA
92234-4277
US

V. Phone/Fax

Practice location:
  • Phone: 714-536-2514
  • Fax:
Mailing address:
  • Phone: 760-835-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220139704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: