Individual
LOUIS A. PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 DEMOSS ST., LORDSBURG, NM 88045-2618
(575) 542-2313
Mailing address
530 DEMOSS ST., LORDSBURG, NM 88045-2618
(575) 542-2313
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD2016-0288
NM
291U00000X
Clinical Medical Laboratory
G72343
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23451246
—
NM
01
—
520681KYWY
MEDICARE PTAN
NM
Enumeration date
02/21/2015
Last updated
11/04/2016
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