Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003240136 |
---|---|
Provider Name | Jessica Pena |
First Address | Norwalk, CA 90650-4328 |
Second Address | Norwalk, CA 90650-4328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 26/08/2013 |