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General NPI Number Information
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NPI Number | 1366375743
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Entity Type | Individual
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Provider Name | MIRANDA PENA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 404 W KINGSBURY ST
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City | SEGUIN
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State | TX
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Zip | 78155-2630
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Country | US
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Telephone | 830-708-4692
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Fax | 210-571-1704
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Provider Business Mailing Address
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Address Line | 502 COMMERCIAL LOOP APT 4211
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City | SAN MARCOS
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State | TX
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Zip | 78666-1466
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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 |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 125120
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License Number State | TX
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