Provider Demographics
NPI:1003520883
Name:PENA, CLARISSA ANN
Entity Type:Individual
Prefix:
First Name:CLARISSA ANN
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3937 THOUSAND OAKS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1956
Mailing Address - Country:US
Mailing Address - Phone:210-888-1281
Mailing Address - Fax:210-888-1283
Practice Address - Street 1:3937 THOUSAND OAKS DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1956
Practice Address - Country:US
Practice Address - Phone:210-888-1281
Practice Address - Fax:210-888-1283
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies