Healthcare Provider Details

I. General information

NPI: 1225519390
Provider Name (Legal Business Name): CLARA SELENE PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S MAIN ST
DONNA TX
78537-3228
US

IV. Provider business mailing address

216 S MAIN ST
DONNA TX
78537-3228
US

V. Phone/Fax

Practice location:
  • Phone: 956-464-2386
  • Fax: 956-464-2210
Mailing address:
  • Phone: 956-464-2386
  • Fax: 956-464-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number145132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: