Healthcare Provider Details

I. General information

NPI: 1992867857
Provider Name (Legal Business Name): JORGE L PENA RUIZ I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PENA L JORGE I MD

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ARZUAGA #112 RIO PIEDRAS
SAN JUAN PR
00925
US

IV. Provider business mailing address

URB.LAS SERRANIA CALLE MADRIGAL #4
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-8758
  • Fax: 844-759-2967
Mailing address:
  • Phone: 787-376-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1992867857
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8626
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: