Healthcare Provider Details

I. General information

NPI: 1780325704
Provider Name (Legal Business Name): BRIAN ELLIOTT MASSA-PENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST STE 202
HIALEAH FL
33016-1898
US

IV. Provider business mailing address

8015 NW 104TH AVE APT 3
DORAL FL
33178-4483
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-2107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME175364
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: