Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME037404 | FL |
NPI | 1326079690 |
---|---|
Provider Name | Heriberto Pena |
First Address | Homestead, FL 33030-4400 |
Second Address | Homestead, FL 33030-4400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 21/01/2008 |