Provider Demographics
NPI:1023307956
Name:PENA, DARCY (CSFA, CST)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:CSFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W BOUTZ RD
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:575-532-7006
Practice Address - Street 1:4143 LA PURISIMA DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8430
Practice Address - Country:US
Practice Address - Phone:575-805-5801
Practice Address - Fax:575-532-7006
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant