Provider Demographics
NPI:1316571912
Name:DE PENA GOMEZ, CHARITIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARITIN
Middle Name:
Last Name:DE PENA GOMEZ
Suffix:
Gender:F
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:L11 CALLE RONDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2309
Mailing Address - Country:US
Mailing Address - Phone:787-525-8376
Mailing Address - Fax:
Practice Address - Street 1:L11 CALLE RONDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2309
Practice Address - Country:US
Practice Address - Phone:787-525-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21702208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice