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General NPI Number Information
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NPI Number | 1982182184
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Entity Type | Individual
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Provider Name | RUBENS DE LA PENA MIR APRN
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Gender | Male
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 933 BROWN CHAPEL RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-2043
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Country | US
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Telephone | 786-970-2112
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Fax |
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Provider Business Mailing Address
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Address Line | 4212 FLORA VISTA DR
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City | ORLANDO
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State | FL
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Zip | 32837-4794
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Country | US
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Telephone | 786-970-2112
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9401713
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN9401713
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License Number State | FL
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