Healthcare Provider Details

I. General information

NPI: 1518843978
Provider Name (Legal Business Name): ANNALISSA LORENA DALAN PENA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNALISSA PENA NP

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WILLOW RD
PLEASANTON CA
94588-8517
US

IV. Provider business mailing address

768 ANTIQUITY DR
FAIRFIELD CA
94534-6613
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-0470
  • Fax: 844-830-3541
Mailing address:
  • Phone: 707-290-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: