Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003110354 |
---|---|
Provider Name | Mr. Eduardo David Pena |
First Address | El Paso, TX 79902-5578 |
Second Address | El Paso, TX 79902-5578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2010 |
Last Update Date | 30/12/2010 |