Provider Demographics
NPI:1093167199
Name:PENARANDA, VIVIAN ISABEL
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ISABEL
Last Name:PENARANDA
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 1:110 BODEGA LN
Mailing Address - Street 2:AP E
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1434
Mailing Address - Country:US
Mailing Address - Phone:805-708-8296
Mailing Address - Fax:
Practice Address - Street 1:110 BODEGA LN
Practice Address - Street 2:AP E
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1434
Practice Address - Country:US
Practice Address - Phone:805-708-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)