Provider Demographics
NPI:1659499424
Name:PENUELA, ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:
Last Name:PENUELA
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 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-678-2652
Mailing Address - Fax:561-964-4603
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:STE 102
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-967-5033
Practice Address - Fax:561-967-5417
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116823207RC0000X, 207RC0000X
LAMD.201812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE009433800Medicaid
FLHN358XMedicare PIN