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General NPI Number Information
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NPI Number | 1144723545
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Entity Type | Individual
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Provider Name | CARLOS ANTONIO PENA DC
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Gender | Male
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 19273 NW 27TH AVE APT 3412
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-2577
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Country | US
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Telephone | 404-984-8465
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 CHEROKEE TRL
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City | WOODSTOCK
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State | GA
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Zip | 30189-3606
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Country | US
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Telephone | 404-984-8465
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR010025
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH13049
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License Number State | FL
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