Provider Demographics
NPI:1982343257
Name:PENA, GABRIELLA ALEXANDRA
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:ALEXANDRA
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 1:4014 MAGDALENA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-6766
Mailing Address - Country:US
Mailing Address - Phone:956-360-0651
Mailing Address - Fax:
Practice Address - Street 1:4014 MAGDALENA ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-6766
Practice Address - Country:US
Practice Address - Phone:956-360-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care