Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | MD21750 | DC |
NPI | 1770673147 |
---|---|
Provider Name | Maria Pena |
First Address | Washington, DC 20010-2978 |
Second Address | Washington, DC 20010-2978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G29184 | (02) |