Healthcare Provider Details

I. General information

NPI: 1386746634
Provider Name (Legal Business Name): MARY KAREN PENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 AVE FONT MARTELO
HUMACAO PR
00791
US

IV. Provider business mailing address

334 AVE FONT MARTELO
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0886
  • Fax: 787-852-0280
Mailing address:
  • Phone: 787-852-0886
  • Fax: 787-852-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12866
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: