Provider Demographics
NPI:1083054324
Name:PENALVER, RONOEL (MD)
Entity Type:Individual
Prefix:
First Name:RONOEL
Middle Name:
Last Name:PENALVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2289
Mailing Address - Country:US
Mailing Address - Phone:813-653-3111
Mailing Address - Fax:813-653-1384
Practice Address - Street 1:10081 PINES BLVD STE B
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6171
Practice Address - Country:US
Practice Address - Phone:786-470-0024
Practice Address - Fax:954-944-5966
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIQ162ZMedicare PIN