Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | ME138795 | FL |
NPI | 1033559455 |
---|---|
Provider Name | Damaris Elixandra Pena |
First Address | Sebring, FL 33872-2171 |
Second Address | Sebring, FL 33872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2013 |
Last Update Date | 03/08/2021 |