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General NPI Number Information
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NPI Number | 1598087108
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Entity Type | Organization
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Legal Business Name | ROBERTO M. PENA, MD PA
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 2911 MEDICAL ARTS ST BUILDING #14
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City | AUSTIN
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State | TX
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Zip | 78705-3376
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Country | US
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Telephone | 512-477-4693
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Fax | 512-477-2160
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Provider Business Mailing Address
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Address Line | 2911 MEDICAL ARTS ST BUILDING #14
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City | AUSTIN
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State | TX
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Zip | 78705-3376
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Country | US
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Telephone | 512-477-4693
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Fax | 512-477-2160
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERTO MATTA PENA
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Credential | MD
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Telephone | 512-477-4693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G3051
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License Number State | TX
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