Provider Demographics
NPI:1356675722
Name:VALERIA ANA PENELA A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:VALERIA ANA PENELA A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:PENELA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-623-7681
Mailing Address - Street 1:1334 WESTWOOD BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4951
Mailing Address - Country:US
Mailing Address - Phone:310-623-7681
Mailing Address - Fax:
Practice Address - Street 1:1334 WESTWOOD BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4951
Practice Address - Country:US
Practice Address - Phone:310-623-7681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20934103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty