Provider Demographics
NPI:1740294545
Name:PENALVER, ALBERTO A (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:A
Last Name:PENALVER
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 1:2780 SW 37TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2740
Mailing Address - Country:US
Mailing Address - Phone:305-646-0112
Mailing Address - Fax:
Practice Address - Street 1:2780 SW 37TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-646-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME605972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0564362-00Medicaid
FL14231Medicare PIN
FLF04295Medicare UPIN