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NPI Code Detail

MEDICARE: ANNA MARIE PENA

MEDICARE: ANNA MARIE PENA
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
1261Q00000XClinic/Center39-07CA
2101YA0400XAddiction (Substance Use Disorder) Counselor6197CA

General Provider Information

NPI Number : 1972667236
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA MARIE PENA
Provider Business Mailing Address
First Line : 1111 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number :
Provider Business Practice Location Address
First Line : 1111 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number : 209-938-0281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 12/22/2023

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Directions to “ ANNA MARIE PENA ” Practice Location

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