Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | J9778 | TX |
Y | 2080P0210X | Pediatric Nephrologist | ME56326 | FL |
NPI | 1669483855 |
---|---|
Provider Name | Deogracias R Pena |
First Address | Orlando, FL 32803-1456 |
Second Address | Orlando, FL 32803-1456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 06/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00U87Z | BCBSTX GRP PIN (01) | TX |
10010075 | AMERIGROUP PIN (01) | TX |
109517 | SUPERIOR PIN (01) | TX |
121266102 | FIRSTCARE PIN (01) | TX |
133426012 | (05) | TX |
1443501 | UHC PIN (01) | TX |
1750369203 | GRP NPI NUMBER (01) | |
5056081 | AETNA PIN (01) | TX |
75208965 | CIGNA PIN (01) | TX |
87Y112 | BCBSTX PIN (01) | TX |
E91527 | (02) |