Provider Demographics
NPI:1780742288
Name:PENA, ROBERTO BERTRAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:BERTRAN
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:TULANE ST #404
Mailing Address - Street 2:ESTANCRAS DE TORTUGUERO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-6234
Mailing Address - Fax:
Practice Address - Street 1:AV JOSE CANDELA #1
Practice Address - Street 2:SUITE 201 MANATI MEDICAL PLAZA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-6800
Practice Address - Fax:787-884-6800
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10079208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37254Medicare UPIN
PR0081822Medicare ID - Type Unspecified