Provider Demographics
NPI:1952802803
Name:PENG, VIVIENNE WEIJU (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:VIVIENNE
Middle Name:WEIJU
Last Name:PENG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:WEI JU
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:11718 SILVER BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-8423
Mailing Address - Country:US
Mailing Address - Phone:626-688-0151
Mailing Address - Fax:
Practice Address - Street 1:1720 W BALL RD STE 4C
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5591
Practice Address - Country:US
Practice Address - Phone:626-688-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849198163W00000X
CA95033318363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse