Organization
OMAR J PENA LOPEZ MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR J PENA LOPEZ M.D. (OWNER)
(956) 971-8100
Entity
Organization
Contact information
Practice address
200 W. EDINBURG HWY 107, ELSA, TX 78543
(956) 262-9805
(956) 971-8102
Mailing address
1403 CARNELIAN DR, WESLACO, TX 78596-4388
(956) 971-8100
(956) 971-8102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N1058
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154255701
—
TX
01
—
1619149762
NPI INDIVIDUAL
TX
Enumeration date
04/05/2012
Last updated
04/05/2012
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