Basic Information
| Provider Information | |||||||||
| NPI: | 1811360969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 VALDOSA | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780435006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567405252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1505 CALLE DEL NORTE | ||||||||
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| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567226221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2015 | ||||||||
| LastUpdateDate: | 06/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 3421 | CA | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 2355S0801X | 38612 | TX | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 235Z00000X | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 114682 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.