Individual
MR. ROBERT DE LA PENA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-0982
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146L00000X
NPI
TX
Enumeration date
04/07/2019
Last updated
04/07/2019
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