Provider Demographics
NPI:1205312857
Name:PENA, ERIKA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 S MARYLAND PKWY UNIT R1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7544
Mailing Address - Country:US
Mailing Address - Phone:702-406-9618
Mailing Address - Fax:702-488-2433
Practice Address - Street 1:3823 S MARYLAND PKWY UNIT R1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7544
Practice Address - Country:US
Practice Address - Phone:702-406-9618
Practice Address - Fax:702-488-2433
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant