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General NPI Number Information
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NPI Number | 1346829579
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Entity Type | Individual
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Provider Name | DEYANIRA PENA-PLACENCIA INDEPENDENT CONTRACT
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 4 MONROE ST # 2A
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City | PASSAIC
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State | NJ
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Zip | 07055-8108
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Country | US
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Telephone | 973-405-8595
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Fax | 973-779-4804
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Provider Business Mailing Address
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Address Line | 4 MONROE ST
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City | PASSAIC
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State | NJ
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Zip | 07055-8108
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Country | US
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Telephone | 973-405-8595
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Fax | 973-779-4804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 331L00000X
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Taxonomy Name | Blood Bank
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License Number |
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License Number State |
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