Imelda Pena, CPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

1312 Issued in TX

Practice address

12315 Judson Rd Ste 206
Live Oak, TX 78233-3264

Phone

(210) 657-8100

Fax

(210) 657-8105

NPI assigned

Nov 6, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Orthopedic Designs, LLC

  • Prosthetic/Orthotic Supplier
  • San Antonio, TX
  • NPI 1639837925

  Orthotist

  NPD
• Advanced Orthopedic Designs, LLC

  • Prosthetic/Orthotic Supplier
  • Dallas, TX
  • NPI 1568651131

  Orthotist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1508639964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12315 JUDSON RD STE 206",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333264",
            "telephone_number": "210-657-8100",
            "fax_number": "210-657-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12315 JUDSON RD STE 206",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333264",
            "telephone_number": "210-657-8100",
            "fax_number": "210-657-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "IMELDA",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "TX",
            "license": "1312",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "TX",
            "license": "1312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Essence Patterson
• Isabel Rose Guihama Paulk, LMSW
• Peak Emg PLLC
• Pediatric Cardiology Consultants of South Texas
• Ashleigh Pena Cavazos
• Vanessa Cantu Peralez
• Shane Pereira, DPT
• Jesus Perez Romo
• Alfred Gene Perez
• Cecilia Perez

• Prosthetist in Live Oak, TX
• Providers in Live Oak, TX by specialty
• Prosthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.