Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 35087432 | OH |
Y | 208C00000X | Colorectal Surgeon | 0056140 | CO |
NPI | 1528023447 |
---|---|
Provider Name | Alberto Pena |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 15/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0307822 | (05) | OH |
100012670A | (05) | IN |
1528023447 | (05) | CO |
65901886 | (05) | KY |
B58785 | (02) |