Healthcare Provider Details

I. General information

NPI: 1003394537
Provider Name (Legal Business Name): RAMON VINICIO PENA GALVAN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax:
Mailing address:
  • Phone: 920-509-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8555-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: