Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A61340 | CA |
NPI | 1003836974 |
---|---|
Provider Name | Dr. Raymond J Pena |
First Address | Reedley, CA 93654-2449 |
Second Address | Reedley, CA 93654-2449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 26/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G86184 | (02) | CA |