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General NPI Number Information
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NPI Number | 1215190723
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Entity Type | Organization
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Legal Business Name | WILLIAM PENA MD LLC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD SUITE 416
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1015
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Country | US
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Telephone | 954-436-3331
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Fax | 954-436-3430
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Provider Business Mailing Address
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Address Line | 601 N FLAMINGO RD SUITE 315-A
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1015
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Country | US
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Telephone | 954-436-3331
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Fax | 954-436-3430
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM PENA
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Credential | M.D.
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Telephone | 945-439-8859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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