Provider Demographics
NPI:1770868622
Name:PENA, LORENA CAROLINA (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:LORENA
Middle Name:CAROLINA
Last Name:PENA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W MCINTYRE ST
Mailing Address - Street 2:APT 3
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2906
Mailing Address - Country:US
Mailing Address - Phone:956-984-9344
Mailing Address - Fax:
Practice Address - Street 1:1601 W MCINTYRE ST
Practice Address - Street 2:APT 3
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2906
Practice Address - Country:US
Practice Address - Phone:956-984-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81913133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered