Provider Demographics
NPI:1023384799
Name:PENAS, ANA PATRICIA
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:PATRICIA
Last Name:PENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6816
Mailing Address - Country:US
Mailing Address - Phone:786-953-8378
Mailing Address - Fax:786-464-0624
Practice Address - Street 1:3121 PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6816
Practice Address - Country:US
Practice Address - Phone:786-953-8378
Practice Address - Fax:786-464-0624
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 65505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist