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General NPI Number Information
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NPI Number | 1952802803
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Entity Type | Individual
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Provider Name | VIVIENNE WEIJU PENG PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1720 W BALL RD STE 4C
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City | ANAHEIM
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State | CA
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Zip | 92804-5591
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Country | US
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Telephone | 626-688-0151
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Fax | 714-683-1473
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Provider Business Mailing Address
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Address Line | 11718 SILVER BIRCH RD
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City | CORONA
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State | CA
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Zip | 92883-8423
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Country | US
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Telephone | 626-688-0151
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 849198
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95033318
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License Number State | CA
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