MEDICARE: DR. JOSE R PENA V MD

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
1	174400000X	Specialist	4367	PR

General Provider Information

NPI Number	:	1689766677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE R PENA V MD

Provider Business Mailing Address
First Line	:	E18 CALLE CORRIENTE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6107
Country	:	US
Telephone Number	:	787-720-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 AVE LAUREL
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-4816
Country	:	US
Telephone Number	:	787-787-5151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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