Provider Demographics
NPI:1629835889
Name:PENA, GUADALUPE ESTELLA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:ESTELLA
Last Name: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 1:409 HEREFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2054
Mailing Address - Country:US
Mailing Address - Phone:512-788-2440
Mailing Address - Fax:
Practice Address - Street 1:405 HEREFORD LOOP
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2054
Practice Address - Country:US
Practice Address - Phone:512-788-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide