Healthcare Provider Details

I. General information

NPI: 1164527065
Provider Name (Legal Business Name): RODOLFO PENA-ARIET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13595 ATLANTIC BLVD STE A
JACKSONVILLE FL
32225-3256
US

IV. Provider business mailing address

13595 ATLANTIC BLVD STE A
JACKSONVILLE FL
32225-3256
US

V. Phone/Fax

Practice location:
  • Phone: 904-221-4325
  • Fax: 904-221-9167
Mailing address:
  • Phone: 904-221-4325
  • Fax: 904-221-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME58288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: