MEDICARE: MRS. LORNA M PENA M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3279	PR

General Provider Information

NPI Number	:	1619116688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORNA M PENA M.A.

Provider Business Mailing Address
First Line	:	PO BOX 190044
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-0044
Country	:	US
Telephone Number	:	787-638-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE MUNOZ RIVERA
Second Line	:	SUITE 608
City	:	SAN JUAN
State	:	PR
Zip	:	00918-1808
Country	:	US
Telephone Number	:	787-638-2656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/13/2009

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