Provider Demographics
NPI:1427295047
Name:PENA GUDINO, CLAUDIA NORA
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:NORA
Last Name:PENA GUDINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ROCKWOOD AVE STE A
Mailing Address - Street 2:PMB 41152
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4700
Mailing Address - Country:US
Mailing Address - Phone:760-455-7470
Mailing Address - Fax:
Practice Address - Street 1:CALLE 11 Y VALLE VERDE
Practice Address - Street 2:COL. BAJA CALIDORNIA
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21130
Practice Address - Country:MX
Practice Address - Phone:686-551-4599
Practice Address - Fax:686-551-4599
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29228791223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMXI1001070OtherID PROVEEDOR