Provider Demographics
NPI:1336475011
Name:MUJICA, MARIBEL PENA
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:PENA
Last Name:MUJICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 CHAPARRAL DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2523
Mailing Address - Country:US
Mailing Address - Phone:832-877-0619
Mailing Address - Fax:281-420-1372
Practice Address - Street 1:4501 CHAPARRAL DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2523
Practice Address - Country:US
Practice Address - Phone:832-877-0619
Practice Address - Fax:281-420-1372
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator