Provider Demographics
NPI:1225246994
Name:PENA, OSIEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:OSIEL
Middle Name:
Last Name:PENA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CENTRAL PKWY N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5052
Mailing Address - Country:US
Mailing Address - Phone:800-404-6050
Mailing Address - Fax:
Practice Address - Street 1:3701 KIRBY DR
Practice Address - Street 2:SUITE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3900
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10431111NR0200X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L23176Medicare UPIN