Provider Demographics
NPI:1194188029
Name:PENTON, ANA ODALYS
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ODALYS
Last Name:PENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 E 3RD ST APT 317
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4971
Mailing Address - Country:US
Mailing Address - Phone:405-609-4567
Mailing Address - Fax:
Practice Address - Street 1:149 E 3RD ST APT 317
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4971
Practice Address - Country:US
Practice Address - Phone:405-609-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator