Healthcare Provider Details

I. General information

NPI: 1548814338
Provider Name (Legal Business Name): JOSE FERNANDO ARENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SW 73RD CT APT 809
PINECREST FL
33156-2952
US

IV. Provider business mailing address

9055 SW 73RD CT APT 809
PINECREST FL
33156-2952
US

V. Phone/Fax

Practice location:
  • Phone: 240-281-4252
  • Fax:
Mailing address:
  • Phone: 240-281-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number18294
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: