Provider Demographics
NPI:1275768160
Name:MELISSA PENA
Entity Type:Organization
Organization Name:MELISSA PENA
Other - Org Name:MY GENERATION ZONE DURABLE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-739-6584
Mailing Address - Street 1:715 E. EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:TX
Mailing Address - Zip Code:78595-0263
Mailing Address - Country:US
Mailing Address - Phone:956-485-9770
Mailing Address - Fax:
Practice Address - Street 1:715 E. EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:TX
Practice Address - Zip Code:78595-0263
Practice Address - Country:US
Practice Address - Phone:956-485-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6189080001Medicare NSC