Healthcare Provider Details

I. General information

NPI: 1720392541
Provider Name (Legal Business Name): MARISA PENA-ALFARO LCCE, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14680 PERTHSHIRE RD APT A
HOUSTON TX
77079-7636
US

IV. Provider business mailing address

14680 PERTHSHIRE RD APT A
HOUSTON TX
77079-7636
US

V. Phone/Fax

Practice location:
  • Phone: 713-823-5033
  • Fax:
Mailing address:
  • Phone: 713-823-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number4020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: