Healthcare Provider Details

I. General information

NPI: 1225246994
Provider Name (Legal Business Name): OSIEL PENA JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 KIRBY DR SUITE 600
HOUSTON TX
77098-3900
US

IV. Provider business mailing address

911 CENTRAL PKWY N SUITE 300
SAN ANTONIO TX
78232-5052
US

V. Phone/Fax

Practice location:
  • Phone: 800-404-6050
  • Fax:
Mailing address:
  • Phone: 800-404-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number10431
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number10431
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: