Provider Demographics
NPI:1174045074
Name:PENA, SILVIA JEANNETTE
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:JEANNETTE
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 1:450 E SAN JACINTO AVE # 1
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2833
Mailing Address - Country:US
Mailing Address - Phone:951-443-2200
Mailing Address - Fax:
Practice Address - Street 1:450 E SAN JACINTO AVE # 1
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2833
Practice Address - Country:US
Practice Address - Phone:951-443-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker