Individual
MR. DANIEL PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LPTA
Contact information
Practice address
4501 BIGGS AVENUE BLDG 939, KIRTLAND AFB, NM 87117-1908
(505) 846-7377
Mailing address
7413 LUELLA ANNE DR NE, ALBUQUERQUE, NM 87109-3935
(505) 872-2000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
A-287
NM
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020802030
BOARD OF CERTIFICATON FOR ATHLETIC TRAINERS
—
Enumeration date
10/11/2006
Last updated
01/31/2018
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