Provider Demographics
NPI:1093010084
Name:PENNY LANE
Entity Type:Organization
Organization Name:PENNY LANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RAHABILITATION SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-944-0594
Mailing Address - Street 1:37151 101ST ST E
Mailing Address - Street 2:
Mailing Address - City:LITTLEROCK
Mailing Address - State:CA
Mailing Address - Zip Code:93543-2032
Mailing Address - Country:US
Mailing Address - Phone:661-944-0594
Mailing Address - Fax:
Practice Address - Street 1:37151 101ST ST E
Practice Address - Street 2:
Practice Address - City:LITTLEROCK
Practice Address - State:CA
Practice Address - Zip Code:93543-2032
Practice Address - Country:US
Practice Address - Phone:661-944-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health