Provider Demographics
NPI:1396438206
Name:FILPO PENA, CARLOS DAVID
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:DAVID
Last Name:FILPO PENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 ORCHARD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2397
Mailing Address - Country:US
Mailing Address - Phone:904-356-4507
Mailing Address - Fax:
Practice Address - Street 1:14905 ORCHARD GROVE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2397
Practice Address - Country:US
Practice Address - Phone:904-356-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001320130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse