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NPI Code Detail

MEDICARE: MISS ASHLEY PENA RD, LD, CNSC

MEDICARE: MISS ASHLEY PENA RD, LD, CNSC
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
1133V00000XRegistered DietitianDT82179TX

General Provider Information

NPI Number : 1760805063
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ASHLEY PENA RD, LD, CNSC
Provider Business Mailing Address
First Line : 2800 SHORELINE DR STE 120
Second Line :
City : DENTON
State : TX
Zip : 76210-0130
Country : US
Telephone Number : 940-383-1240
Fax Number :
Provider Business Practice Location Address
First Line : 2800 SHORELINE DR STE 120
Second Line :
City : DENTON
State : TX
Zip : 76210-0130
Country : US
Telephone Number : 940-383-1240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2014
Last Update Date : 05/15/2015

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