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Organization
PENNY LANE
Active
Organization
PENNY LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS MARQUIS NELSON (CFS)
(661) 272-4883
Entity
Organization
Contact information
Practice address
190 SIERRA CT, PALMDALE, CA 93550-7607
(661) 272-4883
(661) 272-1005
Mailing address
190 SIERRA CT, PALMDALE, CA 93550-7607
(661) 272-4883
(661) 272-1005
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/31/2009
Last updated
07/31/2009
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