Provider Demographics
NPI:1396968970
Name:NORIEGA, HENRY PETER (PA)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:PETER
Last Name:NORIEGA
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 1:15135 NW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1364
Mailing Address - Country:US
Mailing Address - Phone:305-747-8866
Mailing Address - Fax:
Practice Address - Street 1:27 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4613
Practice Address - Country:US
Practice Address - Phone:305-747-8866
Practice Address - Fax:305-747-8866
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA91000829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2805AMedicare ID - Type Unspecified
FLS84943Medicare UPIN