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General NPI Number Information
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NPI Number | 1134496474
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Entity Type | Organization
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Legal Business Name | OMAR J PENA LOPEZ MD PA
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 1403 CARNELIAN DR
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City | WESLACO
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State | TX
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Zip | 78596-4388
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Country | US
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Telephone | 956-307-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 CARNELIAN DR
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City | WESLACO
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State | TX
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Zip | 78596-4388
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OMAR J PENA
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Credential | MD
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Telephone | 956-307-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N1058
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License Number State | TX
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