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General NPI Number Information
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NPI Number | 1669740460
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Entity Type | Organization
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Legal Business Name | AMANDO PENA JR
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 7251 E HWY 83
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City | RIO GRANDE CITY
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State | TX
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Zip | 78582-6347
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Country | US
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Telephone | 956-488-8048
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Fax | 956-488-0476
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Provider Business Mailing Address
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Address Line | 7251 E HWY 83
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City | RIO GRANDE CITY
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State | TX
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Zip | 78582-6347
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Country | US
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Telephone | 956-488-8048
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Fax | 956-488-0476
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Authorized Official
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Title or Position | OWNER
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Name | AMANDO PENA JR.
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Credential |
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Telephone | 956-488-8048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1000795
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License Number State | TX
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