Provider Demographics
NPI:1265072151
Name:PENA, CINDY D
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:D
Last Name:PENA
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 1:751 E DAILY DR STE 310
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6077
Mailing Address - Country:US
Mailing Address - Phone:805-914-4113
Mailing Address - Fax:
Practice Address - Street 1:751 E DAILY DR STE 310
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6077
Practice Address - Country:US
Practice Address - Phone:805-914-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker