Provider Demographics
NPI:1285216622
Name:PENA, ALEJANDRA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:DEL CARMEN
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 NW 199TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5902
Mailing Address - Country:US
Mailing Address - Phone:786-973-2939
Mailing Address - Fax:
Practice Address - Street 1:4306 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2840
Practice Address - Country:US
Practice Address - Phone:305-535-3300
Practice Address - Fax:305-535-3324
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner