Individual
RANDALL PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 RAILROAD AVE APT 1, LAS VEGAS, NM 87701-3934
(505) 454-5128
(505) 454-0397
Mailing address
411 RAILROAD AVE APT 1, LAS VEGAS, NM 87701-3934
(505) 454-5128
(505) 454-0397
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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