Provider Demographics
NPI:1891416103
Name:PENA VALENZUELA, REBECA CELMIRA
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:CELMIRA
Last Name:PENA VALENZUELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:CELMIRA
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 W THORNTON PKWY LOT 391
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5424
Mailing Address - Country:US
Mailing Address - Phone:720-284-1846
Mailing Address - Fax:
Practice Address - Street 1:1700 WHEELING ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7211
Practice Address - Country:US
Practice Address - Phone:720-723-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO530107010133521183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician