Healthcare Provider Details

I. General information

NPI: 1972764306
Provider Name (Legal Business Name): RICARDO PENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

1200 WILSHIRE BLVD
LOS ANGELES CA
90017-1908
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax: 213-481-7147
Mailing address:
  • Phone: 213-481-7464
  • Fax: 213-481-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW29832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: