Provider Demographics
NPI:1356441125
Name:PENA, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:625 ST. CHARLES AVE
Mailing Address - Street 2:#10E
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130
Mailing Address - Country:US
Mailing Address - Phone:504-524-3653
Mailing Address - Fax:504-524-3653
Practice Address - Street 1:1430 TULANE AVE
Practice Address - Street 2:DEPT. OF PSYCHIATRY, TULANE SOM
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-988-5405
Practice Address - Fax:504-988-6531
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2018-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.0159902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry