Provider Demographics
NPI:1538373600
Name:PENA, ORLANDO (LCDO)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:LCDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE B-F35
Mailing Address - Street 2:REPARTO MONTELLANO
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-738-3876
Mailing Address - Fax:787-274-8477
Practice Address - Street 1:CALLE B-F35
Practice Address - Street 2:REPARTO MONTELLANO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-3876
Practice Address - Fax:787-274-8477
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1466Medicare UPIN