Healthcare Provider Details

I. General information

NPI: 1679776330
Provider Name (Legal Business Name): JULIO M. DE PENA M.D., FAAEM, FAWM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JULIO MANUEL DE PENA BATISTA M.D.

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 04/15/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

PO BOX 100186
GAINESVILLE FL
32610-0186
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax:
Mailing address:
  • Phone: 352-265-5911
  • Fax: 352-265-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAP111825
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME102367
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME102367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: