Provider Demographics
NPI:1235296500
Name:PENA, ELVIN B (OD)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:B
Last Name:PENA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:216 CALLE MUNOZ RIVERA S
Mailing Address - Street 2:PLAZA BUXO 3
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-4215
Mailing Address - Country:US
Mailing Address - Phone:787-736-2465
Mailing Address - Fax:787-736-1565
Practice Address - Street 1:216 CALLE MUNOZ RIVERA S
Practice Address - Street 2:PLAZA BUXO 3
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4215
Practice Address - Country:US
Practice Address - Phone:787-736-2465
Practice Address - Fax:787-736-1565
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPR0484OtherEYE MED
PR2352OtherAMERICAN HEALTH
PR6170OtherAMERICAN HEATH MADICARE
PR7413OtherIMC FIRST MEDICAL
PR068484OtherGLOBAL HEALTH PLAN
PR077153OtherCRUZ AZUL
PR61413OtherSSS MEDICARE OPTIMO
PR890224OtherMMM
PR215132OtherPREFERRED (UTI)
PR61413OtherSSS
PR7540054OtherHUMANA
PR7540054OtherHUMANA REFORMA
PR7540054OtherHUMANA