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General NPI Number Information
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NPI Number | 1518760149
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Entity Type | Individual
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Provider Name | THERESA MARIE PENA RDH
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Gender | Female
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 1428 PHILLIPS LN STE 101
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2550
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Country | US
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Telephone | 805-242-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 401 YERBA BUENA ST
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City | MORRO BAY
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State | CA
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Zip | 93442-2973
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Country | US
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Telephone | 805-540-9340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21606
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License Number State | CA
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