Individual
ELIZABETH TOMMIE PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ELIZABETH
Contact information
Practice address
400 E ROYAL LN BLDG 3, IRVING, TX 75039-3540
(855) 832-6727
Mailing address
4575 SE DIXIE HWY, STUART, FL 34997-6826
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
28141898
TX
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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