Provider Demographics
NPI:1043083074
Name:PENA, BETHZAIRA
Entity Type:Individual
Prefix:
First Name:BETHZAIRA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49869 CALHOUN ST STE 204&205
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-9720
Mailing Address - Country:US
Mailing Address - Phone:760-398-9090
Mailing Address - Fax:760-391-5338
Practice Address - Street 1:49869 CALHOUN ST STE 204&205
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-9720
Practice Address - Country:US
Practice Address - Phone:760-398-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator