Basic Information
| Provider Information | |||||||||
| NPI: | 1760988810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENA PINEDO | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | ANTONIO | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20946 BRYANT ST APT 20 | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913042805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183225841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14535 SHERMAN CIR | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014930 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW80179 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.