Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053902700 |
---|---|
Provider Name | Geraldine Pena |
First Address | Northridge, CA 91325-2003 |
Second Address | Northridge, CA 91325-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2021 |
Last Update Date | 26/01/2021 |