Provider Demographics
NPI:1407516784
Name:BARRIOS PENA, ANGEL FERNANDO (SA-C)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:FERNANDO
Last Name:BARRIOS PENA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19315 JUNIPER VALE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7067
Mailing Address - Country:US
Mailing Address - Phone:832-834-2882
Mailing Address - Fax:
Practice Address - Street 1:19315 JUNIPER VALE CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7067
Practice Address - Country:US
Practice Address - Phone:832-834-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21-740246ZC0007X
FL9637717163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant