Individual
LEA PENUELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-1000
Mailing address
400 N PEPPER AVE, COLTON, CA 92324-1801
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
691049
CA
207L00000X
Anesthesiology Physician
138937
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95001896
CA
Other
Enumeration date
06/16/2022
Last updated
11/16/2022
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