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General NPI Number Information
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NPI Number | 1962133207
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Entity Type | Organization
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Legal Business Name | MARIASOL PENA MD
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 11375 LOCH LOMOND RD
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2913
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Country | US
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Telephone | 626-422-4058
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Fax |
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Provider Business Mailing Address
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Address Line | 11278 LOS ALAMITOS BLVD # 162
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3958
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARIASOL PENA
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Credential | MD
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Telephone | 626-442-4058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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