Provider Demographics
NPI:1477673929
Name:JOSE F. PENA
Entity Type:Organization
Organization Name:JOSE F. PENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9564-464-2402
Mailing Address - Street 1:307 N SALINAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2929
Mailing Address - Country:US
Mailing Address - Phone:956-464-2402
Mailing Address - Fax:956-464-5608
Practice Address - Street 1:307 N SALINAS BLVD
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2929
Practice Address - Country:US
Practice Address - Phone:956-464-2402
Practice Address - Fax:956-464-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG13752Medicare UPIN