Healthcare Provider Details

I. General information

NPI: 1053215541
Provider Name (Legal Business Name): KENIA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19064 SW 319TH ST
HOMESTEAD FL
33030-5310
US

IV. Provider business mailing address

19064 SW 319TH ST
HOMESTEAD FL
33030-5310
US

V. Phone/Fax

Practice location:
  • Phone: 786-499-4004
  • Fax:
Mailing address:
  • Phone: 786-499-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSTUDENT
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: