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NPI Code Detail

MEDICARE: DR. CARLOS PENA M.D.

MEDICARE: DR. CARLOS PENA M.D.
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
1207RN0300XNephrology PhysicianME54800FL
2174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669435988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLOS PENA M.D.
Provider Business Mailing Address
First Line : 16501 NW 2ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33169-6005
Country : US
Telephone Number : 305-354-4558
Fax Number :
Provider Business Practice Location Address
First Line : 16501 NW 2ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33169-6005
Country : US
Telephone Number : 305-354-4558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2006
Last Update Date : 11/03/2022

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Directions to “ DR. CARLOS PENA M.D.” Practice Location

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