Healthcare Provider Details

I. General information

NPI: 1205659638
Provider Name (Legal Business Name): PENELOPE CIFUENTES MA, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TOFT ST
MOUNTAIN VIEW CA
94041-1727
US

IV. Provider business mailing address

3212 HOOVER ST
REDWOOD CITY CA
94063-4318
US

V. Phone/Fax

Practice location:
  • Phone: 650-526-3590
  • Fax:
Mailing address:
  • Phone: 650-575-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240171850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: