Provider Demographics
NPI:1629276662
Name:PENA-GONZALEZ, ARLENE LYDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:LYDIA
Last Name:PENA-GONZALEZ
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 1:2800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1370
Mailing Address - Country:US
Mailing Address - Phone:954-484-0051
Mailing Address - Fax:954-485-4452
Practice Address - Street 1:2800 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1370
Practice Address - Country:US
Practice Address - Phone:954-484-0051
Practice Address - Fax:954-485-4452
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58742251S00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME58742OtherPSYCHIATRIC LICENSE
FL317262100Medicaid
FL317262100Medicaid