Provider Demographics
NPI:1073376885
Name:PENA CANTILLO, LIUNIS (SA-C)
Entity Type:Individual
Prefix:
First Name:LIUNIS
Middle Name:
Last Name:PENA CANTILLO
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 COLLINS CREEK DR APT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-5371
Mailing Address - Country:US
Mailing Address - Phone:305-780-9440
Mailing Address - Fax:
Practice Address - Street 1:3007 COLLINS CREEK DR APT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-5371
Practice Address - Country:US
Practice Address - Phone:305-780-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23-668246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant