Provider Demographics
NPI:1700214368
Name:JOSE M PENA MD PA
Entity Type:Organization
Organization Name:JOSE M PENA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-774-0742
Mailing Address - Street 1:165 SW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1240
Mailing Address - Country:US
Mailing Address - Phone:305-774-0742
Mailing Address - Fax:305-774-0836
Practice Address - Street 1:14740 SW 26TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5830
Practice Address - Country:US
Practice Address - Phone:305-774-0742
Practice Address - Fax:305-774-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty