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General NPI Number Information
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NPI Number | 1427305796
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Entity Type | Individual
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Provider Name | MARIA LUISA PENA DDS
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 9565 W ATLANTIC BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6943
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Country | US
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Telephone | 954-575-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 9066 SW 73RD CT APT 910
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City | MIAMI
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State | FL
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Zip | 33156-2968
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Country | US
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Telephone | 305-989-2296
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 19909
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License Number State | FL
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