Individual
FERNANDO JOSE PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC II
Contact information
Practice address
10209 SE DIVISION ST, BLDG D, PORTLAND, OR 97266-1372
(503) 716-0481
(503) 208-2596
Mailing address
PO BOX 16756, PORTLAND, OR 97292-0756
(503) 593-2129
(503) 208-2596
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14-11-18
OR
Other
Enumeration date
12/09/2011
Last updated
07/27/2016
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