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General NPI Number Information
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NPI Number | 1477174993
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Entity Type | Individual
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Provider Name | ARVIN PENACERRADA
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Gender | Male
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 111 VISION PARK BLVD STE 250
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City | SHENANDOAH
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State | TX
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Zip | 77384-3004
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Country | US
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Telephone | 469-909-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 4115 LOUETTA RD APT 4303
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City | SPRING
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State | TX
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Zip | 77388-4879
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 170495
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License Number State | MD
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