Provider Demographics
NPI:1952353278
Name:JORGE LUIS PENA JR
Entity Type:Organization
Organization Name:JORGE LUIS PENA JR
Other - Org Name:GUARDIAN EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:PENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-262-7434
Mailing Address - Street 1:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-2911
Mailing Address - Country:US
Mailing Address - Phone:956-262-7434
Mailing Address - Fax:956-262-6946
Practice Address - Street 1:703 W CIRO CASARES
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543
Practice Address - Country:US
Practice Address - Phone:956-262-7434
Practice Address - Fax:956-262-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178479501Medicaid
TXAMB481Medicare PIN