Healthcare Provider Details

I. General information

NPI: 1790597664
Provider Name (Legal Business Name): MARIA VICTORIA PENA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3849 E FOOTHILL BLVD
PASADENA CA
91107-2204
US

IV. Provider business mailing address

14142 TIARA ST APT 1
VAN NUYS CA
91401-3647
US

V. Phone/Fax

Practice location:
  • Phone: 626-469-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95033651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: