Healthcare Provider Details

I. General information

NPI: 1104759083
Provider Name (Legal Business Name): TERESA A PENALOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 JOHN ST STE A
SALINAS CA
93901-3345
US

IV. Provider business mailing address

751 MEYERS CT
SALINAS CA
93905-2105
US

V. Phone/Fax

Practice location:
  • Phone: 831-225-6717
  • Fax:
Mailing address:
  • Phone: 831-262-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: