Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 10431 | TX |
N | 213ER0200X | Radiology | 10431 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 10431 | TX |
NPI | 1225246994 |
---|---|
Provider Name | Dr. Osiel Pena JR. |
First Address | San Antonio, TX 78232-5052 |
Second Address | Houston, TX 77098-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 14/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8L23176 | (02) |