Provider Demographics
NPI:1386233906
Name:PENALES, VENN WILFRED MADERAZO
Entity type:Individual
Prefix:
First Name:VENN WILFRED
Middle Name:MADERAZO
Last Name:PENALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 THE ALAMEDA STE 316
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1461
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-642-6052
Practice Address - Street 1:101 JOSE FIGUERES AVE STE 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2068
Practice Address - Country:US
Practice Address - Phone:408-207-0560
Practice Address - Fax:408-642-6052
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95345111163WP0808X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health