Provider Demographics
NPI:1285863381
Name:PENA, CLEOFAS (PA)
Entity Type:Individual
Prefix:MR
First Name:CLEOFAS
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 TREASURE HILLS BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8913
Mailing Address - Country:US
Mailing Address - Phone:956-425-9240
Mailing Address - Fax:956-412-8575
Practice Address - Street 1:1713 TREASURE HILLS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8913
Practice Address - Country:US
Practice Address - Phone:956-425-9240
Practice Address - Fax:956-412-8575
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05330363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05330OtherSTATE PERMIT
TXV0154186OtherDPS
TXMP1893127OtherDEA