Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH9373 | FL |
NPI | 1003098658 |
---|---|
Provider Name | Dr. William Pena |
First Address | Miami, FL 33133-2211 |
Second Address | Miami, FL 33133-2211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 05/12/2007 |