MEDICARE: MS. MARISA PENA-ALFARO LCCE, CD

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	374J00000X	Doula	4020	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720392541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISA PENA-ALFARO LCCE, CD

Provider Business Mailing Address
First Line	:	14680 PERTHSHIRE RD APT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-7636
Country	:	US
Telephone Number	:	713-823-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	14680 PERTHSHIRE RD APT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-7636
Country	:	US
Telephone Number	:	713-823-5033
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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Directions to “ MS. MARISA PENA-ALFARO LCCE, CD” Practice Location

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