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General NPI Number Information
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NPI Number | 1053341214
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Entity Type | Individual
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Provider Name | LUIS PENATE-PEREZ
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 8200 SW 117TH AVE SUITE 112
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City | MIAMI
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State | FL
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Zip | 33183-3856
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Country | US
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Telephone | 305-596-7432
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Fax | 888-715-1420
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Provider Business Mailing Address
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Address Line | 8200 SW 117TH AVE SUITE 112
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City | MIAMI
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State | FL
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Zip | 33183-1428
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Country | US
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Telephone | 305-596-7432
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Fax | 888-715-1420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME93736
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License Number State | FL
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