MEDICARE: MS. ANNA MARISA PENA RD/LD

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
1	133V00000X	Registered Dietitian	DT06181	TX

General Provider Information

NPI Number	:	1215129903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA MARISA PENA RD/LD

Provider Business Mailing Address
First Line	:	9535 YEARLING BRANCH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-4833
Country	:	US
Telephone Number	:	713-480-3752
Fax Number	:

Provider Business Practice Location Address
First Line	:	9950 CYPRESSWOOD DR STE 205
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3481
Country	:	US
Telephone Number	:	832-453-5336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/15/2007

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