Provider Demographics
NPI:1891030896
Name:PENADES, MARIA ELENA (IBLCE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:PENADES
Suffix:
Gender:F
Credentials:IBLCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7126
Mailing Address - Country:US
Mailing Address - Phone:954-274-2634
Mailing Address - Fax:
Practice Address - Street 1:9690 W SAMPLE RD
Practice Address - Street 2:204
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4046
Practice Address - Country:US
Practice Address - Phone:954-274-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11274945174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN