Provider Demographics
NPI:1578942231
Name:PENA, KAYLIN (CSFA,CST)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:CSFA,CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2552
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-2552
Mailing Address - Country:US
Mailing Address - Phone:678-315-8501
Mailing Address - Fax:
Practice Address - Street 1:850 WINDY HILL RD SE
Practice Address - Street 2:2552
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30081-3109
Practice Address - Country:US
Practice Address - Phone:678-315-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant