Individual
CARLOS EDWARDO PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8402 W INTERSTATE HIGHWAY 2, MISSION, TX 78572-2072
(956) 580-0432
Mailing address
8402 W INTERSTATE HIGHWAY 2, MISSION, TX 78572-2072
(956) 580-0432
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32019553943
—
TX
Enumeration date
01/02/2017
Last updated
01/02/2017
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