Healthcare Provider Details

I. General information

NPI: 1710630181
Provider Name (Legal Business Name): HECTOR PENA-GONZALEZ MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 FOREST HILL BLVD
WEST PALM BEACH FL
33415-5640
US

IV. Provider business mailing address

4670 FOREST HILL BLVD
WEST PALM BEACH FL
33415-5640
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-7614
  • Fax: 561-247-7819
Mailing address:
  • Phone: 561-247-7819
  • Fax: 561-247-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1527
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23004
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: