Organization
PENNY LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSENIA J SANDOVAL BS (SOCIAL WORKER)
(661) 274-0770
Entity
Organization
Contact information
Practice address
43520 DIVISION ST, LANCASTER, CA 93535-4089
(661) 274-0770
(661) 274-9970
Mailing address
43520 DIVISION ST, LANCASTER, CA 93535-4089
(661) 274-0770
(661) 274-9970
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
12/30/2013
Last updated
12/30/2013
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