Provider Demographics
NPI:1639332554
Name:PENA, JENNIFER M (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name: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:PO BOX 9023938
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3938
Mailing Address - Country:US
Mailing Address - Phone:466-498-3505
Mailing Address - Fax:
Practice Address - Street 1:1452 ASHFORD AVE
Practice Address - Street 2:CONDOMINIA ADA LIGIA, PH12B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00902
Practice Address - Country:US
Practice Address - Phone:646-498-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301130207R00000X
VA0101247664207R00000X
CAC161524207R00000X, 207R00000X
FLME139541207R00000X, 207R00000X
TXS2146207R00000X, 207R00000X
PR022831207R00000X
TN59075207R00000X
GA85158207R00000X
KS04-43047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine