Healthcare Provider Details

I. General information

NPI: 1255591137
Provider Name (Legal Business Name): MRS. ELSI L PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 BISCAYNE BLVD # 300
MIAMI FL
33137-3840
US

IV. Provider business mailing address

511 NW 82ND AVE APT 413
MIAMI FL
33126-3993
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-1234
  • Fax: 305-571-2020
Mailing address:
  • Phone: 305-264-5816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: