Individual
IMELDA PENA RIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
903 W MARTIN ST, SAN ANTONIO, TX 78207-0903
(210) 358-3555
(210) 358-5945
Mailing address
7703 FLOYD CURL DR # MC7977, SAN ANTONIO, TX 78229-3901
(210) 358-3555
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP131249
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
361477802
—
TX
01
—
361477803
CSHCN
TX
01
—
524216YLPS
WELLMED MEDICARE
TX
Enumeration date
06/29/2016
Last updated
03/17/2018
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