Provider Demographics
NPI:1053133074
Name:PENA, DANIEL AMBIORIX I
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:AMBIORIX
Last Name:PENA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CLEBURNE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4501
Mailing Address - Country:US
Mailing Address - Phone:701-301-3059
Mailing Address - Fax:
Practice Address - Street 1:3100 CLEBURNE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4501
Practice Address - Country:US
Practice Address - Phone:701-301-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program