Provider Demographics
NPI:1003435736
Name:PENA, FERNANDO ANDRES (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ANDRES
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 1:100 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2213
Mailing Address - Country:US
Mailing Address - Phone:956-929-3995
Mailing Address - Fax:
Practice Address - Street 1:100 BLUEBIRD AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2213
Practice Address - Country:US
Practice Address - Phone:956-929-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2024-06-13
Deactivation Date:2020-09-20
Deactivation Code:
Reactivation Date:2024-06-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program