MEDICARE: MEGAN PENA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1851177810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN PENA

Provider Business Mailing Address
First Line	:	1609 N INTERNATIONAL BLVD
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-0285
Country	:	US
Telephone Number	:	956-405-3690
Fax Number	:	956-405-3691

Provider Business Practice Location Address
First Line	:	1609 N INTERNATIONAL BLVD
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-0285
Country	:	US
Telephone Number	:	956-405-3690
Fax Number	:	956-405-3691

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

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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Directions to “ MEGAN PENA ” Practice Location

Language	Start Address	Practice Location

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