Provider Demographics
NPI:1235763426
Name:PENA, LUCY J
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:J
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LUCY
Other - Middle Name:J
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28106 SUGARSIDE GLEN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:832-264-3644
Mailing Address - Fax:
Practice Address - Street 1:28106 SUGARSIDE GLEN DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:832-264-3644
Practice Address - Fax:281-493-7028
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty