Provider Demographics
NPI:1982216370
Name:PENAFIEL, JOY BALTAZAR
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:BALTAZAR
Last Name:PENAFIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 E HANBURY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1846
Mailing Address - Country:US
Mailing Address - Phone:626-825-2921
Mailing Address - Fax:
Practice Address - Street 1:5218 E HANBURY ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1846
Practice Address - Country:US
Practice Address - Phone:626-825-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2021-07-15
Deactivation Date:2021-06-08
Deactivation Code:
Reactivation Date:2021-07-15
Provider Licenses
StateLicense IDTaxonomies
376K00000X
CA00910592376K00000X
CAR1393620620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No376K00000XNursing Service Related ProvidersNurse's Aide