Provider Demographics
NPI:1083398846
Name:PENUELAS, MAGDALENA A
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:A
Last Name:PENUELAS
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 1:125 W THOUSAND OAKS BLVD SUITE #500
Mailing Address - Street 2:
Mailing Address - City:THOUS OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6083
Mailing Address - Country:US
Mailing Address - Phone:805-873-3883
Mailing Address - Fax:
Practice Address - Street 1:125 W THOUSAND OAKS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4462
Practice Address - Country:US
Practice Address - Phone:805-873-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)