Provider Demographics
NPI:1205659638
Name:CIFUENTES, PENELOPE (MA, PPS)
Entity type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:MA, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4318
Mailing Address - Country:US
Mailing Address - Phone:650-575-1371
Mailing Address - Fax:
Practice Address - Street 1:500 TOFT ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1727
Practice Address - Country:US
Practice Address - Phone:650-526-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240171850101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool