Provider Demographics
NPI:1508001835
Name:PENA, MARILYN LEE (CRTT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:LEE
Last Name:PENA
Suffix:
Gender:F
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W MAGEE RD APT 5101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4666
Mailing Address - Country:US
Mailing Address - Phone:520-300-1551
Mailing Address - Fax:
Practice Address - Street 1:699 W MAGEE RD APT 5101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4666
Practice Address - Country:US
Practice Address - Phone:520-300-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0065382278C0205X, 2278E0002X, 2278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical Care
No2278E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEmergency Care
No2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care