Provider Demographics
NPI:1609804624
Name:RICHARD J PENA- ARIET MD PA
Entity Type:Organization
Organization Name:RICHARD J PENA- ARIET MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENA ARIET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-879-1112
Mailing Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1709
Mailing Address - Country:US
Mailing Address - Phone:772-879-1112
Mailing Address - Fax:772-879-1167
Practice Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1709
Practice Address - Country:US
Practice Address - Phone:772-879-1112
Practice Address - Fax:772-879-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7184385OtherAETNA
FL265063100Medicaid
FL265063100Medicaid
FLAH182Medicare PIN
FL7184385OtherAETNA