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NPI Code Detail

MEDICARE: MARY E PENA L.P.C.

MEDICARE: MARY E PENA L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor61089TX
2101Y00000XCounselor61089TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083739197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E PENA L.P.C.
Provider Business Mailing Address
First Line : 801 W. 1ST STREET
Second Line :
City : SAN JUAN
State : TX
Zip : 78589-2276
Country : US
Telephone Number : 956-787-8915
Fax Number : 956-787-2021
Provider Business Practice Location Address
First Line : 801 W. 1ST STREET
Second Line :
City : SAN JUAN
State : TX
Zip : 78589-2276
Country : US
Telephone Number : 956-631-9000
Fax Number : 956-631-9013
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 09/07/2011

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Directions to “ MARY E PENA L.P.C.” Practice Location

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