Provider Demographics
NPI:1710630181
Name:PENA-GONZALEZ, HECTOR (MS)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:PENA-GONZALEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5640
Mailing Address - Country:US
Mailing Address - Phone:561-247-7819
Mailing Address - Fax:561-247-7614
Practice Address - Street 1:4670 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5640
Practice Address - Country:US
Practice Address - Phone:561-247-7614
Practice Address - Fax:561-247-7819
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1527208D00000X
PR23004208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program