Healthcare Provider Details

I. General information

NPI: 1821974049
Provider Name (Legal Business Name): YOMEIDA DE LA PENA MS, LAT, ATC, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 MCKINZIE RD
CORPUS CHRISTI TX
78410
US

IV. Provider business mailing address

544 OLYMPIC
PORTLAND TX
78374-1241
US

V. Phone/Fax

Practice location:
  • Phone: 361-903-6725
  • Fax:
Mailing address:
  • Phone: 832-332-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number5977
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: