Provider Demographics
NPI:1205430675
Name:PENA, DIANA MARISOL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARISOL
Last Name:PENA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 IH 69 ACCESS RD STE C
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-4543
Mailing Address - Country:US
Mailing Address - Phone:361-241-9381
Mailing Address - Fax:361-241-2661
Practice Address - Street 1:4101 IH 69 ACCESS RD STE C
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-4543
Practice Address - Country:US
Practice Address - Phone:361-241-9381
Practice Address - Fax:361-241-2661
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist