1710437009 NPI number — PENNY LANE CENTERS

Table of content: MRS. DONNA MARIA SALERNO LPC (NPI 1982915849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710437009 NPI number — PENNY LANE CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNY LANE CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PENNY LANE CENTERS-SATELLITE III
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710437009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15305 RAYEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91343-5117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-892-3423
Provider Business Mailing Address Fax Number:
818-892-3574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13804 OSBORNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91331-6035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-893-8826
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LA FIANZA
Authorized Official First Name:
ROSANA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CLINIC OPERATIONS
Authorized Official Telephone Number:
818-892-3423

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  191202002 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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