Provider Demographics
NPI:1588427157
Name:BARAHONA VEGA, PENELOPE L (SENIOR CAREGIVER)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:L
Last Name:BARAHONA VEGA
Suffix:
Gender:F
Credentials:SENIOR CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29655 JORDAN CROSSING BLVD
Mailing Address - Street 2:APT. 1107
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423
Mailing Address - Country:US
Mailing Address - Phone:979-422-1404
Mailing Address - Fax:
Practice Address - Street 1:29655 JORDAN CROSSING BLVD
Practice Address - Street 2:APT. 1107
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423
Practice Address - Country:US
Practice Address - Phone:979-422-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care