Provider Demographics
NPI:1457584518
Name:PENA, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:SOUTH POINT
Other - Last Name:EMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1523 W EXPRESSWAY STE A
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4300
Mailing Address - Country:US
Mailing Address - Phone:956-262-6205
Mailing Address - Fax:
Practice Address - Street 1:1523 W EXPRESSWAY STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4300
Practice Address - Country:US
Practice Address - Phone:956-262-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance