MEDICARE: PENA-SAMPER MEDICAL ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME38971	FL
2	207RH0003X	Hematology & Oncology Physician	ME51328	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME51328	OTHER	FL	FL LICENSE
2	ME38971	OTHER	FL	FL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114108172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENA-SAMPER MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	7820 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3852
Country	:	US
Telephone Number	:	813-935-6334
Fax Number	:	813-935-5237

Provider Business Practice Location Address
First Line	:	7820 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3852
Country	:	US
Telephone Number	:	813-935-6334
Fax Number	:	813-935-5237

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KATHERINE MARCELA PENA-PERILLA
Credential	:
Telephone Number	:	813-935-6334

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	07/21/2015

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