Provider Demographics
NPI:1043721160
Name:PENA, ISRAEL (ATC, LAT, CES)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 FM 32
Mailing Address - Street 2:
Mailing Address - City:FISCHER
Mailing Address - State:TX
Mailing Address - Zip Code:78623-2424
Mailing Address - Country:US
Mailing Address - Phone:830-885-1751
Mailing Address - Fax:
Practice Address - Street 1:8555 FM 32
Practice Address - Street 2:
Practice Address - City:FISCHER
Practice Address - State:TX
Practice Address - Zip Code:78623-2424
Practice Address - Country:US
Practice Address - Phone:830-885-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer