Provider Demographics
NPI:1255666327
Name:PENA, GRISEL (BS)
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 87TH AVE
Mailing Address - Street 2:J216
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4585
Mailing Address - Country:US
Mailing Address - Phone:954-263-7925
Mailing Address - Fax:
Practice Address - Street 1:200 NW 87TH AVE
Practice Address - Street 2:J216
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4585
Practice Address - Country:US
Practice Address - Phone:954-263-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator