1235296500 NPI number — DR. ELVIN B PENA O.D.

Table of content: (NPI 1114920329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235296500 NPI number — DR. ELVIN B PENA O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENA
Provider First Name:
ELVIN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235296500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 CALLE MUNOZ RIVERA S
Provider Second Line Business Mailing Address:
PLAZA BUXO 3
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00754-4215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-736-2465
Provider Business Mailing Address Fax Number:
787-736-1565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 CALLE MUNOZ RIVERA S
Provider Second Line Business Practice Location Address:
PLAZA BUXO 3
Provider Business Practice Location Address City Name:
SAN LORENZO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00754-4215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-736-2465
Provider Business Practice Location Address Fax Number:
787-736-1565
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  484 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PR0484 . This is a "EYE MED" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2352 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6170 . This is a "AMERICAN HEATH MADICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7413 . This is a "IMC FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 068484 . This is a "GLOBAL HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 077153 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 61413 . This is a "SSS MEDICARE OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 890224 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 215132 . This is a "PREFERRED (UTI)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 61413 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7540054 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7540054 . This is a "HUMANA REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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