Provider Demographics
NPI:1942235940
Name:PENA, JORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8045
Mailing Address - Country:US
Mailing Address - Phone:626-447-4343
Mailing Address - Fax:
Practice Address - Street 1:600 N GARFIELD AVE STE 311
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1171
Practice Address - Country:US
Practice Address - Phone:626-280-0408
Practice Address - Fax:626-280-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29890207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A298900Medicaid
CAHA29890AMedicare PIN
CAHA29890BMedicare PIN
CAHA29890Medicare PIN
CA00A298900Medicaid
CA110015651Medicare PIN
CAA29890Medicare PIN
CAA87287Medicare UPIN
CAHA29890CMedicare PIN