Provider Demographics
NPI:1861031130
Name:PENA, ISRAEL JR (RRT)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:PENA
Suffix:JR
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 N 40TH LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3466
Mailing Address - Country:US
Mailing Address - Phone:956-789-1117
Mailing Address - Fax:
Practice Address - Street 1:1118 N 40TH LN
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3466
Practice Address - Country:US
Practice Address - Phone:956-789-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RCP00066947227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered