Provider Demographics
NPI:1659307486
Name:PENA, RAFAEL EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:PENA
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 1:5224 SR 46 # 376
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9230
Mailing Address - Country:US
Mailing Address - Phone:407-444-4848
Mailing Address - Fax:407-444-4870
Practice Address - Street 1:1331 S INTERNATIONAL PKWY STE 1261
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:407-444-4848
Practice Address - Fax:407-444-4870
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137799207RC0001X
PAMD065965L207RC0000X
NJ25MA08150300207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
JL066ZOtherMEDICARE
NJ223505477OtherTIN
NJ462009036OtherTIN
PA232571699OtherTIN
PA232571699OtherTIN
NJ223505477OtherTIN