Healthcare Provider Details

I. General information

NPI: 1578141545
Provider Name (Legal Business Name): STEFANIE ANGELINE PENA ADRIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE ANGELINE PENA MD

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 TERRACINA BLVD
REDLANDS CA
92373-4847
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 909-328-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA206376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: