Healthcare Provider Details

I. General information

NPI: 1952353278
Provider Name (Legal Business Name): JORGE LUIS PENA JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 W CIRO CASARES
ELSA TX
78543
US

IV. Provider business mailing address

PO BOX 2911
ELSA TX
78543-2911
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-7434
  • Fax: 956-262-6946
Mailing address:
  • Phone: 956-262-7434
  • Fax: 956-262-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE LUIS PENA JR.
Title or Position: OWNER
Credential:
Phone: 956-262-7434