Basic Information
| Provider Information | |||||||||
| NPI: | 1346769718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5085 NW 7TH ST APT 704 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054907110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20900 BISCAYNE BLVD | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056827000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2017 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9266597 | FL | N | Nursing Service Providers | Registered Nurse | 367500000X | ARNP9266597 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.