Healthcare Provider Details

I. General information

NPI: 1457562159
Provider Name (Legal Business Name): LUIS JAVIER PENA-HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 204
ATLANTIS FL
33462-6637
US

IV. Provider business mailing address

5401 S CONGRESS AVE STE 204
ATLANTIS FL
33462-6637
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-4118
  • Fax:
Mailing address:
  • Phone: 561-967-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME117319
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085441
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME117319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: