Healthcare Provider Details

I. General information

NPI: 1831015668
Provider Name (Legal Business Name): GRODY PENALVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 SW 47TH ST
MIAMI FL
33155-5410
US

IV. Provider business mailing address

8601 SW 47TH ST
MIAMI FL
33155-5410
US

V. Phone/Fax

Practice location:
  • Phone: 786-985-9342
  • Fax:
Mailing address:
  • Phone: 786-985-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9552993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: