Healthcare Provider Details

I. General information

NPI: 1649295114
Provider Name (Legal Business Name): ALBERT DE LA PENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 W WHITTIER BLVD
MONTEBELLO CA
90640-3041
US

IV. Provider business mailing address

2446 W WHITTIER BLVD
MONTEBELLO CA
90640-3041
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-5500
  • Fax: 323-728-4408
Mailing address:
  • Phone: 323-728-5500
  • Fax: 323-728-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA26114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: