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General NPI Number Information
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NPI Number | 1821430745
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Entity Type | Individual
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Provider Name | GEMINIS PENA DIETITIAN
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 801 W 1ST ST
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City | SAN JUAN
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State | TX
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Zip | 78589-2276
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Country | US
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Telephone | 956-787-8915
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Fax | 956-787-2021
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Provider Business Mailing Address
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Address Line | 801 W 1ST ST
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City | SAN JUAN
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State | TX
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Zip | 78589-2276
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Country | US
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Telephone | 956-787-8915
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Fax | 956-787-2021
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DT82788
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License Number State | TX
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