Healthcare Provider Details

I. General information

NPI: 1982938759
Provider Name (Legal Business Name): CHRISTINA PENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 N KENDALL DR SUITE 507
MIAMI FL
33156-7706
US

IV. Provider business mailing address

7400 N KENDALL DR SUITE 507
MIAMI FL
33156-7706
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-8727
  • Fax: 305-227-8731
Mailing address:
  • Phone: 305-227-8727
  • Fax: 305-227-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberFL ME104880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: