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General NPI Number Information
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NPI Number | 1235630989
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Entity Type | Organization
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Legal Business Name | DR. CESAR PENA MD, PA
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 3232 BROADWAY BLVD STE A
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City | GARLAND
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State | TX
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Zip | 75043-1728
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Country | US
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Telephone | 972-905-5134
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 LBJ FWY STE 425
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City | DALLAS
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State | TX
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Zip | 75243-2057
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Country | US
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Telephone | 817-565-3288
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LISA JACKSON
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Credential |
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Telephone | 817-565-3288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L7105
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License Number State | TX
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