Provider Demographics
NPI:1356561815
Name:PENELA, VALERIA ANA (PSY D, PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:ANA
Last Name:PENELA
Suffix:
Gender:F
Credentials:PSY D, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 CORINTH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3232
Mailing Address - Country:US
Mailing Address - Phone:310-623-7681
Mailing Address - Fax:310-829-7868
Practice Address - Street 1:3201 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2337
Practice Address - Country:US
Practice Address - Phone:310-623-7681
Practice Address - Fax:310-829-7868
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20934103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist