Provider Demographics
NPI:1013054535
Name:PENAS, JOSE (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:PENAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW 216TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1003
Mailing Address - Country:US
Mailing Address - Phone:305-253-5100
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 216TH STREET
Practice Address - Street 2:WALK-INS SERVICE DEPT
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190
Practice Address - Country:US
Practice Address - Phone:305-235-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9101022363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9101022OtherSTATE LICENSE