Healthcare Provider Details

I. General information

NPI: 1568005411
Provider Name (Legal Business Name): DEPENA HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 SW 24TH ST STE 316
MIAMI FL
33155-1692
US

IV. Provider business mailing address

7171 SW 24TH ST STE 316
MIAMI FL
33155-1692
US

V. Phone/Fax

Practice location:
  • Phone: 786-762-2415
  • Fax: 786-762-2418
Mailing address:
  • Phone: 786-762-2415
  • Fax: 786-762-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FLORENCIO DEPENA
Title or Position: PRESIDENT
Credential: MD
Phone: 786-762-2415