Provider Demographics
NPI:1851774186
Name:DE LA PENA, TERRI (RDHAP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:DE LA PENA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10011 SHAGGYBARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1136
Mailing Address - Country:US
Mailing Address - Phone:619-316-9319
Mailing Address - Fax:866-316-9391
Practice Address - Street 1:10011 SHAGGYBARK DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1136
Practice Address - Country:US
Practice Address - Phone:619-316-9319
Practice Address - Fax:866-316-9391
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist