Individual
PETER QUINTIN PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
36325 SMOKE BUSH RD, LUCERNE VALLEY, CA 92356-7511
(916) 595-2303
Mailing address
36325 SMOKE BUSH RD, LUCERNE VALLEY, CA 92356-7511
(916) 595-2303
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
12/11/2019
Last updated
12/11/2019
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