Individual
ARVIN PENACERRADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 VISION PARK BLVD STE 250, SHENANDOAH, TX 77384-3004
(469) 909-2511
Mailing address
4115 LOUETTA RD APT 4303, SPRING, TX 77388-4879
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
170495
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170495
ARDMS
—
Enumeration date
05/06/2020
Last updated
05/06/2020
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