Healthcare Provider Details

I. General information

NPI: 1982216370
Provider Name (Legal Business Name): JOY BALTAZAR PENAFIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date: 06/08/2021
Reactivation Date: 07/15/2021

III. Provider practice location address

5218 E HANBURY ST
LONG BEACH CA
90808-1846
US

IV. Provider business mailing address

5218 E HANBURY ST
LONG BEACH CA
90808-1846
US

V. Phone/Fax

Practice location:
  • Phone: 626-825-2921
  • Fax:
Mailing address:
  • Phone: 626-825-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00910592
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1393620620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: