Healthcare Provider Details

I. General information

NPI: 1497909444
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH PENA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 CAMPUS DR STE A245
IRVINE CA
92612-8630
US

IV. Provider business mailing address

4255 CAMPUS DR STE A245
IRVINE CA
92612-8630
US

V. Phone/Fax

Practice location:
  • Phone: 949-502-0736
  • Fax: 949-900-2175
Mailing address:
  • Phone: 949-502-0736
  • Fax: 949-900-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: