Juvensa LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

JUVENSA LLC

Practice address

2500 NW 79TH Ave Ste 265
Doral, FL 33122-1088

Phone

(786) 504-4626

Fax

(305) 468-6217

NPI assigned

May 8, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anneyd Avalos Pena

Title

Owner

Phone

(786) 925-3143

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1043900798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9803 SW 134TH PL",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331862265",
            "telephone_number": "786-925-3143",
            "fax_number": "305-468-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NW 79TH AVE STE 265",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331221088",
            "telephone_number": "786-504-4626",
            "fax_number": "305-468-6217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUVENSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "AVALOS PENA",
        "authorized_official_first_name": "ANNEYD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-925-3143"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.