Individual
GRACIE MARIE PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
6831 LOMA SECCA, SAN ANTONIO, TX 78233-5395
(210) 633-4837
Mailing address
6831 LOMA SECCA, SAN ANTONIO, TX 78233-5395
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
346926
TX
Other
Enumeration date
02/19/2019
Last updated
02/19/2019
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