Basic Information
| Provider Information | |||||||||
| NPI: | 1356441125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 ST. CHARLES AVE | ||||||||
| Address2: | #10E | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045243653 | ||||||||
| FaxNumber: | 5045243653 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 TULANE AVE | ||||||||
| Address2: | DEPT. OF PSYCHIATRY, TULANE SOM | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885405 | ||||||||
| FaxNumber: | 5049886531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD.015990 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.