Gustavo Pena Jr.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1441 N Beckley Ave
Dallas, TX 75203-1201

Phone

(214) 942-6115

NPI assigned

Apr 27, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335484800000",
    "number": "1891053708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6118 MADOC FORK DR",
            "address_2": "APT 1212",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761165883",
            "telephone_number": "361-779-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 N BECKLEY AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031201",
            "telephone_number": "214-942-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "GUSTAVO",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-27",
        "last_updated": "2012-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Katheryn Pemberton, RN, FNP
• Helene Nicolle Pena Sahdala, MD
• Melissa Pena Vidal, CRNA
• Adrian Israel Pena
• Blanca Erika Pena, DDS
• Israel Pena, LCDC
• Javier Pena Jr., M.D.
• Jeena Pena
• Jorge Pena, FNP-BC
• Jose Pena, CRNA

• Physician Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; 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.