Provider Demographics
NPI:1518638485
Name:GARCIA PENA, PEDRO (RN)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:GARCIA PENA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 156TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6816
Mailing Address - Country:US
Mailing Address - Phone:253-240-9042
Mailing Address - Fax:
Practice Address - Street 1:8118 156TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6816
Practice Address - Country:US
Practice Address - Phone:253-240-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61185267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse