Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006376 | GA |
NPI | 1003843293 |
---|---|
Provider Name | Dr. Patricia Pena |
First Address | Lawrenceville, GA 30044-8836 |
Second Address | Lawrenceville, GA 30044-8836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 02/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U79091 | (02) | GA |