Provider Demographics
NPI:1972249183
Name:PENATE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PENATE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-772-8224
Mailing Address - Street 1:8200 SW 117TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4825
Mailing Address - Country:US
Mailing Address - Phone:786-272-9170
Mailing Address - Fax:786-245-0751
Practice Address - Street 1:6850 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5114
Practice Address - Country:US
Practice Address - Phone:786-272-9170
Practice Address - Fax:786-245-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty