MEDICARE: PENELOPE ANNE VALENZUELA LMFT

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	106H00000X	Marriage & Family Therapist	19824	CA

General Provider Information

NPI Number	:	1881248706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENELOPE ANNE VALENZUELA LMFT

Provider Business Mailing Address
First Line	:	237 BAGNALL AVENUE
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-1902
Country	:	US
Telephone Number	:	714-313-5545
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 E LA PALMA AVE STE 100G
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2056
Country	:	US
Telephone Number	:	714-349-0614
Fax Number	:

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

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	09/25/2019

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