Provider Demographics
NPI:1003845926
Name:PERNAS, ELENA MARTA (DO)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARTA
Last Name:PERNAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3313
Mailing Address - Country:US
Mailing Address - Phone:305-642-5366
Mailing Address - Fax:305-631-3803
Practice Address - Street 1:11501 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3313
Practice Address - Country:US
Practice Address - Phone:305-642-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH21866Medicare UPIN
FLE4382ZMedicare ID - Type Unspecified