Provider Demographics
NPI:1346421872
Name:PENA, MELISSA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:PENA
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:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-0263
Mailing Address - Country:US
Mailing Address - Phone:956-432-1999
Mailing Address - Fax:
Practice Address - Street 1:715 EAST EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78595-0263
Practice Address - Country:US
Practice Address - Phone:956-432-1999
Practice Address - Fax:956-205-0469
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies