Individual
IMELDA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
12315 JUDSON RD STE 206, LIVE OAK, TX 78233-3264
(210) 657-8100
(210) 657-8105
Mailing address
12315 JUDSON RD STE 206, LIVE OAK, TX 78233-3264
(210) 657-8100
(210) 657-8105
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
1312
TX
224P00000X
Prosthetist
Primary
1312
TX
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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