Provider Demographics
NPI:1851611164
Name:PENA-ROBICHAUX, VENESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VENESSA
Middle Name:
Last Name:PENA-ROBICHAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211B N FM 1626
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610
Mailing Address - Country:US
Mailing Address - Phone:737-717-3244
Mailing Address - Fax:512-318-2537
Practice Address - Street 1:211B N FM 1626
Practice Address - Street 2:SUITE 1A
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610
Practice Address - Country:US
Practice Address - Phone:737-717-3244
Practice Address - Fax:512-318-2537
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9439207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351454YZ4UOtherMEDICARE PTAN
TX335728701Medicaid