Provider Demographics
NPI:1538350970
Name:RENE P. PENA, M.D.,PROF.CORP
Entity type:Organization
Organization Name:RENE P. PENA, M.D.,PROF.CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-649-7300
Mailing Address - Street 1:2031 MCDANIEL ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6303
Mailing Address - Country:US
Mailing Address - Phone:702-649-7300
Mailing Address - Fax:702-649-7306
Practice Address - Street 1:2031 MCDANIEL ST
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6303
Practice Address - Country:US
Practice Address - Phone:702-649-7300
Practice Address - Fax:702-649-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVD10217Medicare UPIN
NVV37035Medicare PIN