Healthcare Provider Details

I. General information

NPI: 1366493850
Provider Name (Legal Business Name): FELIX G PENATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 SW 119TH AVE STE 102
MIAMI FL
33186-6012
US

IV. Provider business mailing address

6450 W 21ST CT STE 200
HIALEAH FL
33016-3942
US

V. Phone/Fax

Practice location:
  • Phone: 786-709-9362
  • Fax: 786-709-9364
Mailing address:
  • Phone: 305-698-0806
  • Fax: 305-698-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: