Individual
MS. BLANCA OLIVIA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2700 N 140TH AVE STE 107, GOODYEAR, AZ 85395-2439
(623) 535-8770
(623) 535-8771
Mailing address
2700 N 140TH AVE STE 107, GOODYEAR, AZ 85395-2439
(623) 535-8770
(623) 535-8771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2013-0061
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080389
—
AZ
Enumeration date
09/11/2013
Last updated
10/28/2020
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