Provider Demographics
NPI:1013182211
Name:PENA, LUZ MAGALI (MD DERMATOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:MAGALI
Last Name:PENA
Suffix:
Gender:F
Credentials:MD DERMATOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9023736
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3736
Mailing Address - Country:US
Mailing Address - Phone:787-724-2876
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE JUAN ANTONIO CORRETJER
Practice Address - Street 2:407
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2607
Practice Address - Country:US
Practice Address - Phone:787-724-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3776207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology