MEDICARE: JENNIFER PENA-WALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1700281979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PENA-WALL

Provider Business Mailing Address
First Line	:	PO BOX 1210
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-1210
Country	:	US
Telephone Number	:	909-825-5588
Fax Number	:	909-825-5340

Provider Business Practice Location Address
First Line	:	201 N INDIAN HILL BLVD STE A-201
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4668
Country	:	US
Telephone Number	:	909-825-5588
Fax Number	:	909-825-5340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	01/06/2026

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Directions to “ JENNIFER PENA-WALL ” Practice Location

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