Provider Demographics
NPI:1720392541
Name:PENA-ALFARO, MARISA (LCCE, CD)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:PENA-ALFARO
Suffix:
Gender:F
Credentials:LCCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14680 PERTHSHIRE RD APT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7636
Mailing Address - Country:US
Mailing Address - Phone:713-823-5033
Mailing Address - Fax:
Practice Address - Street 1:14680 PERTHSHIRE RD APT A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7636
Practice Address - Country:US
Practice Address - Phone:713-823-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4020374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMARISAGENIALMedicaid
TXMARISAGENAILMedicaid
TXMARISAGENAILMedicaid
TXMARISAGENIALMedicare UPIN
TXMARISAGENIALMedicare PIN