Provider Demographics
NPI:1659060119
Name:PENA HILARIO, ESTEFANY (PA, RDMS, SG)
Entity Type:Individual
Prefix:
First Name:ESTEFANY
Middle Name:
Last Name:PENA HILARIO
Suffix:
Gender:F
Credentials:PA, RDMS, SG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AK16 CALLE ANA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4924
Mailing Address - Country:US
Mailing Address - Phone:939-267-8181
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KM11.6
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4924
Practice Address - Country:US
Practice Address - Phone:787-474-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR502-PA363AM0700X
PR0012882085U0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound