Provider Demographics
NPI:1407232937
Name:PENA, RAQUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1780
Mailing Address - Country:US
Mailing Address - Phone:530-795-4377
Mailing Address - Fax:
Practice Address - Street 1:172 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1780
Practice Address - Country:US
Practice Address - Phone:530-795-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical