Provider Demographics
NPI:1598500340
Name:PENA, ERAILIA M
Entity type:Individual
Prefix:
First Name:ERAILIA
Middle Name:M
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 TERMINAL WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2121
Mailing Address - Country:US
Mailing Address - Phone:775-378-5536
Mailing Address - Fax:
Practice Address - Street 1:2760 SANTA ANA DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4971
Practice Address - Country:US
Practice Address - Phone:219-728-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide