Provider Demographics
NPI:1225015852
Name:PENA -ARIET, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:PENA -ARIET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1709
Mailing Address - Country:US
Mailing Address - Phone:772-879-1112
Mailing Address - Fax:772-879-1167
Practice Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1709
Practice Address - Country:US
Practice Address - Phone:772-879-1112
Practice Address - Fax:772-879-1167
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010639109OtherCOMMERCIAL INSURANCE
FL58575OtherBCBS OF FLORIDA
FL010639109Medicaid
FL58575OtherBCBS OF FLORIDA