Provider Demographics
NPI:1013127224
Name:PENA, RICARDO ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:ENRIQUE
Last Name:PENA
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 1:60 CALLE TOPACIO
Mailing Address - Street 2:VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1937
Mailing Address - Country:US
Mailing Address - Phone:787-258-0864
Mailing Address - Fax:
Practice Address - Street 1:60 CALLE TOPACIO
Practice Address - Street 2:VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1937
Practice Address - Country:US
Practice Address - Phone:787-258-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR96662083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice