Individual
JOSE MANUEL PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2274
Mailing address
2401 W ALTA RD APT 602, PEORIA, IL 61615-1287
(602) 999-3249
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125.070535
IL
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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