Healthcare Provider Details

I. General information

NPI: 1780928515
Provider Name (Legal Business Name): PENNY LANE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43423 DIVISION ST SUITE 101
LANCASTER CA
93535-4639
US

IV. Provider business mailing address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4783
  • Fax: 661-266-1210
Mailing address:
  • Phone: 818-892-3423
  • Fax: 818-892-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSANA LA FIANZA
Title or Position: DIRECTOR OF CLINIC OPERATIONS
Credential: MBA
Phone: 818-892-3423