=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306545587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH CHESKA AMULAR PENA DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2023
-----------------------------------------------------
Last Update Date | 08/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21830 NORDHOFF ST
-----------------------------------------------------
City | CHATSWORTH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91311-5761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-727-7820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6318 SHIRLEY AVE
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-6548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-721-6059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 110497
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------