Provider Demographics
NPI:1104602390
Name:PENA DE LA PAZ, CARLA FERNANDA (OTR)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:FERNANDA
Last Name:PENA DE LA PAZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:FERNANDA
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:5215 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3003 SAN ESTEBAN ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-8621
Practice Address - Country:US
Practice Address - Phone:956-776-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist