Provider Demographics
NPI:1457477424
Name:PENA, MACRINA B (NONE)
Entity Type:Individual
Prefix:MISS
First Name:MACRINA
Middle Name:B
Last Name:PENA
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 LAVERNA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2627
Mailing Address - Country:US
Mailing Address - Phone:323-256-8495
Mailing Address - Fax:
Practice Address - Street 1:2308 LAVERNA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2627
Practice Address - Country:US
Practice Address - Phone:323-256-8495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health