# A DE LA PENA M D A MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A. De La Pena MD, AMG, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811901762
- **Authorized official:** ALBERT DE LA PENA M.D. (PRESIDENT/ MEDICAL DIRECTOR)
- **Authorized official phone:** (714) 558-1385

## Contact information

- **Practice address:** 1520 N GRAND AVE, SANTA ANA, CA 92701-2627
- **Practice address phone:** (714) 558-1385
- **Practice address fax:** (714) 558-7269
- **Mailing address:** 2446 W WHITTIER BLVD, MONTEBELLO, CA 90640-3041
- **Mailing address phone:** (323) 728-5500
- **Mailing address fax:** (323) 728-4408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 06/18/2013