Basic Information
| Provider Information | |||||||||
| NPI: | 1467407601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | ALBERTO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 VICTORIA LN STE 2 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785503227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563654400 | ||||||||
| FaxNumber: | 9563654111 | ||||||||
| Practice Location | |||||||||
| Address1: | 533 PECAN BLVD | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785012356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563654400 | ||||||||
| FaxNumber: | 9563654111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | M2444 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | M2444 | TX | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 179928003 | 05 | TX | MEDICAID |