Provider Demographics
NPI:1295270965
Name:PENA, VIRGINIA (MS-IP, BA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:MS-IP, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431 MAGNOLIA AVE
Mailing Address - Street 2:211
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3892
Mailing Address - Country:US
Mailing Address - Phone:951-858-5479
Mailing Address - Fax:
Practice Address - Street 1:626 W ROUTE 66
Practice Address - Street 2:#E
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4103
Practice Address - Country:US
Practice Address - Phone:714-529-2549
Practice Address - Fax:714-529-2532
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician