Individual
NELY PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4196 DOUGLAS BLVD STE 100, GRANITE BAY, CA 95746-5904
(916) 489-1376
(916) 489-1386
Mailing address
PO BOX 5157, MODESTO, CA 95352-5157
(209) 572-2589
(209) 353-3353
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
CA
Other
Enumeration date
06/24/2020
Last updated
06/24/2020
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