Provider Demographics
NPI:1164527065
Name:PENA-ARIET, RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:PENA-ARIET
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 1:13595 ATLANTIC BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3256
Mailing Address - Country:US
Mailing Address - Phone:904-221-4325
Mailing Address - Fax:904-221-9167
Practice Address - Street 1:13595 ATLANTIC BLVD STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3256
Practice Address - Country:US
Practice Address - Phone:904-221-4325
Practice Address - Fax:904-221-9167
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58288208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11327OtherBCBS ID #
FL064381500Medicaid
FL4131917OtherAETNA ID #
FL11327OtherBCBS ID #