Healthcare Provider Details

I. General information

NPI: 1164259966
Provider Name (Legal Business Name): CLINICA DE MEDICINA FAMILIAR DR. FRANKLIN PENA, S.R.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV. MAURICIO BAEZ
SAN PEDRO DE MACORIS DOMINICAN REPUBLIC
21000
DO

IV. Provider business mailing address

PO BOX 11957
FORT LAUDERDALE FL
33339-1957
US

V. Phone/Fax

Practice location:
  • Phone: 954-903-7445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ESMERALDA PENA
Title or Position: MANAGER
Credential:
Phone: 954-526-9751