Healthcare Provider Details

I. General information

NPI: 1003098658
Provider Name (Legal Business Name): WILLIE PENA MD, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH PL
HIALEAH FL
33012-3113
US

IV. Provider business mailing address

520 NE 38TH ST APT 26
MIAMI FL
33137-3770
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-2500
  • Fax:
Mailing address:
  • Phone: 305-558-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME176222
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9373
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME176222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: