Provider Demographics
NPI:1285762831
Name:PENA, ABEL PEREZ
Entity type:Individual
Prefix:MR
First Name:ABEL
Middle Name:PEREZ
Last Name:PENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4899
Mailing Address - Country:US
Mailing Address - Phone:619-401-5500
Mailing Address - Fax:619-401-5454
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4899
Practice Address - Country:US
Practice Address - Phone:619-401-5500
Practice Address - Fax:619-401-5454
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist