Provider Demographics
NPI:1215129903
Name:PENA, ANNA MARISA (RD/LD)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARISA
Last Name:PENA
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 YEARLING BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4833
Mailing Address - Country:US
Mailing Address - Phone:713-480-3752
Mailing Address - Fax:
Practice Address - Street 1:9950 CYPRESSWOOD DR STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3481
Practice Address - Country:US
Practice Address - Phone:832-453-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06181133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered