Provider Demographics
NPI:1922981737
Name:DE LA PENA, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DE LA 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 1:78730 ROCKBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4186
Mailing Address - Country:US
Mailing Address - Phone:760-540-6837
Mailing Address - Fax:
Practice Address - Street 1:44550 VILLAGE CT STE 103
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3817
Practice Address - Country:US
Practice Address - Phone:760-540-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program