Provider Demographics
NPI:1568005411
Name:DEPENA HEALTH GROUP LLC
Entity Type:Organization
Organization Name:DEPENA HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-762-2415
Mailing Address - Street 1:7171 SW 24TH ST STE 316
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1692
Mailing Address - Country:US
Mailing Address - Phone:786-762-2415
Mailing Address - Fax:786-762-2418
Practice Address - Street 1:7171 SW 24TH ST STE 316
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1692
Practice Address - Country:US
Practice Address - Phone:786-762-2415
Practice Address - Fax:786-762-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty