Provider Demographics
NPI:1609216845
Name:PENA, BELEN MARTINEZ (AOD)
Entity Type:Individual
Prefix:MS
First Name:BELEN
Middle Name:MARTINEZ
Last Name:PENA
Suffix:
Gender:F
Credentials:AOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5528
Mailing Address - Country:US
Mailing Address - Phone:951-663-8366
Mailing Address - Fax:
Practice Address - Street 1:245 N MURRAY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5528
Practice Address - Country:US
Practice Address - Phone:951-663-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator