Lorela Pengua, is a
Student In An Organized Health Care Education/training Program based in Myrtle Beach, South Carolina. Lorela Pengua is licensed to practice in Pennsylvania (license number ) and her current practice location is
210 Village Center Blvd Ste 200, Myrtle Beach, South Carolina. She can be reached at her office (for appointments etc.) via phone at
(843) 353-3460.
NPI number for Lorela Pengua is 1619781374 and her current mailing address is 210 Village Center Blvd Ste 140, Myrtle Beach, South Carolina. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1619781374.
Provider's Profile
| Full Name | Lorela Pengua |
|---|
| Gender | Female |
|---|
| Speciality | Student In An Organized Health Care Education/training Program |
|---|
| Location | 210 Village Center Blvd Ste 200, Myrtle Beach, South Carolina |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1619781374
- Provider Enumeration Date: 02/04/2025
- Last Update Date: 02/04/2025
Medical Identifiers
Medical identifiers for Lorela Pengua such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1619781374 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | PENDING (South Carolina) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (Pennsylvania) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lorela Pengua is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Lorela Pengua,
210 Village Center Blvd Ste 140,
Myrtle Beach, SC 29579-6706
Ph: (843) 353-3460 | Lorela Pengua,
210 Village Center Blvd Ste 200,
Myrtle Beach, SC 29579-6706
Ph: (843) 353-3460 |
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