Healthcare Provider Details

I. General information

NPI: 1275156507
Provider Name (Legal Business Name): RACHEL DELA PENA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2083
US

IV. Provider business mailing address

26582 OAKDALE CANYON LN
CANYON COUNTRY CA
91387-8125
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-1083
  • Fax:
Mailing address:
  • Phone: 661-305-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number490444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: