Provider Demographics
NPI:1598114498
Name:PENA CRUZ, FERNANDO LUIS (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:PENA CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 CALLE PAISAJE
Mailing Address - Street 2:REPARTO ANAIDA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4136
Mailing Address - Country:US
Mailing Address - Phone:787-379-6024
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32510-R390200000X
PR13961-I390200000X
390200000X
NY3005822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program