Provider Demographics
NPI:1962863266
Name:AVALOS PENA, ANNEYD M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNEYD
Middle Name:M
Last Name:AVALOS PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9803 SW 134TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2265
Mailing Address - Country:US
Mailing Address - Phone:786-925-3143
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 265
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1088
Practice Address - Country:US
Practice Address - Phone:786-925-3143
Practice Address - Fax:305-274-1470
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN20593207R00000X
FLME132628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine