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NPI Code Detail

MEDICARE: DR. RICARDO PENA M.D.

MEDICARE: DR. RICARDO PENA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0057462FL

General Provider Information

NPI Number : 1639142680
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICARDO PENA M.D.
Provider Business Mailing Address
First Line : 93 DELANNOY AVE
Second Line : APT #606
City : COCOA
State : FL
Zip : 32922-7987
Country : US
Telephone Number : 321-639-1159
Fax Number : 321-637-3619
Provider Business Practice Location Address
First Line : 2900 VETERANS WAY
Second Line :
City : VIERA
State : FL
Zip : 32940-8007
Country : US
Telephone Number : 321-637-3788
Fax Number : 321-637-3619
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 07/08/2007

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Directions to “ DR. RICARDO PENA M.D.” Practice Location

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