Provider Demographics
NPI:1912737602
Name:PENA, VICTOR (RPA)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 N MINNESOTA RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2656
Mailing Address - Country:US
Mailing Address - Phone:956-222-7876
Mailing Address - Fax:
Practice Address - Street 1:1100 E DOVE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4680
Practice Address - Country:US
Practice Address - Phone:956-362-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10TX1418243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant