MEDICARE: DR. JORGE L PENA RUIZ I 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	208000000X	Pediatrics Physician	1992867857	PR
2	208000000X	Pediatrics Physician	8626	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992867857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L PENA RUIZ I MD

Provider Business Mailing Address
First Line	:	URB.LAS SERRANIA
Second Line	:	CALLE MADRIGAL #4
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-376-8930
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE ARZUAGA #112 RIO PIEDRAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	787-767-8758
Fax Number	:	844-759-2967

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	09/20/2022

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Directions to “ DR. JORGE L PENA RUIZ I MD” Practice Location

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