Provider Demographics
NPI:1417031717
Name:PENA, CYNTHIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 B GALE WILSON BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3700
Mailing Address - Country:US
Mailing Address - Phone:707-646-4669
Mailing Address - Fax:707-646-4667
Practice Address - Street 1:1101 B GALE WILSON BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3700
Practice Address - Country:US
Practice Address - Phone:707-646-4669
Practice Address - Fax:707-646-4667
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88607207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05957253OtherECFMG NO.
CAA88607OtherMEDICAL LICENSE
CAA88607OtherMEDICAL LICENSE