Provider Demographics
NPI:1578040309
Name:GARCIA PENA, CLARISA ESMERALDA
Entity Type:Individual
Prefix:
First Name:CLARISA
Middle Name:ESMERALDA
Last Name:GARCIA PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 E MAIN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0932
Mailing Address - Country:US
Mailing Address - Phone:956-581-7200
Mailing Address - Fax:956-581-7201
Practice Address - Street 1:3013 E MAIN AVE STE E
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-0932
Practice Address - Country:US
Practice Address - Phone:956-581-7200
Practice Address - Fax:956-581-7201
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214698224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant