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PRINCESS DELA PENA M.D.
NPI 1659787877
Pediatrics in Manteca, CA

Active since July 08, 2014PECOS Enrolled
165 SAINT DOMINICS DR STE 201, MANTECA, CA 95337(209) 823-2345(209) 239-1154 Get Directions Write a Review

NPPES record last updated: December 22, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 21, 2022, Mar 17, 2018, Sep 12, 2017 (3 updates tracked since 2017).

About Princess Dela Pena M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRINCESS DELA PENA M.D. (NPI 1659787877) is an individual pediatrics provider in Manteca, California, licensed in California (A149269) and active in the NPI registry since July 2014. She is enrolled in Medicare PECOS and maintains a secondary practice location in Lodi.

NPPES Registry Identity

NPI1659787877
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NamePRINCESS DELA PENACredential: M.D.
Location Address165 SAINT DOMINICS DR STE 201Manteca, CA 95337-7802
Mailing AddressPo Box 255228Sacramento, CA 95865-5228
Phone(209) 823-2345
Fax(209) 239-1154
Sole ProprietorNo
Enumeration DateJuly 8, 2014
Last NPPES UpdateDecember 22, 20233 updates tracked since enumeration
NPPES CertifiedDecember 22, 2023
✔ NPI 1659787877 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · A149269
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
165 SAINT DOMINICS DR STE 201, Manteca, CA 95337
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Secondary Practice Location 1

Location 11300 W Lodi Ave Ste PLodi, CA 95242-3038 · Phone (209) 369-7493 · Fax (209) 369-6858

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Princess Dela Pena M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Princess Dela Pena reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sutter Valley Medical Foundation
18 mi
Multi-Specialty
600 COFFEE RD
Modesto, CA 95355
  • Reassigned Medicare billing, California enrollment
  • 3,056 clinicians in this Medicare group
NPI 1669846986 (209) 524-1211

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95337 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SYED RAHMAN M.D.
Family Medicine
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 823-2345
DR. SWATI PATHAK M.D.
Internal Medicine
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 823-2347
SUKALPA CHOWDHURY M.D.
Family Medicine
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 823-2345
DR. BETALINA BLANCO BUMATAY M.D.
Pediatrics
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 823-2345
DR. EMAN H ALBADDAWI M.D
Internal Medicine (Pulmonary Disease)
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 830-4062
BRENDA GUADALUPE MARTINEZ CHAVEZ LCSW
Social Worker (Clinical)
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 830-4062
ERIKA JEAN LEACOX ED.D
Psychologist
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 823-2345
KYI LAY SAN MD
Internal Medicine
165 SAINT DOMINICS DR STE 201
MANTECA, CA 95337
San Joaquin County (209) 823-2345

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Princess Dela Pena's NPI number?

The NPI number for Princess Dela Pena is 1659787877. It was assigned to this individual provider in the NPPES registry on July 8, 2014.

Where is Princess Dela Pena located?

Princess Dela Pena practices at 165 Saint Dominics Dr Ste 201, Manteca, CA 95337. The listed phone number is (209) 823-2345.

What is Princess Dela Pena's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Princess Dela Pena enrolled in Medicare?

Yes. Princess Dela Pena is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Princess Dela Pena's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Princess Dela Pena reassigns Medicare benefits to Sutter Valley Medical Foundation (Modesto, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Princess Dela Pena's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Princess Dela Pena was last updated on December 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.