Peninsula Diagnostics PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

ME30779 Issued in FL

Legal business name

PENINSULA DIAGNOSTICS PA

Practice address

1355 W Palmetto Park Rd
#282
Boca Raton, FL 33486-3330

Phone

(888) 395-4007

Fax

(888) 395-3941

NPI assigned

Jan 14, 2010

Organization subpart

No

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

Authorized official

Name

Russell Packard, MD

Title

Owner

Phone

(888) 395-4007

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1263427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1619207628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 W PALMETTO PARK RD",
            "address_2": "#282",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334863330",
            "telephone_number": "888-395-4007",
            "fax_number": "888-395-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 W PALMETTO PARK RD",
            "address_2": "#282",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334863330",
            "telephone_number": "888-395-4007",
            "fax_number": "888-395-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA DIAGNOSTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-14",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "PACKARD",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-395-4007",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME30779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidy Victoria Pena, RN, IBCLC
• Santiago Pena, PA-C
• Suzanne Pena
• Victor Penagos, HSE 11988
• Penina Flug, LCSW, Inc.
• Startayvia Areiona Penn
• Clair Janine Pennington
• Robert Frank Pennino, D.C.
• Emily Pensler, MS CCC-SLP
• Maria Del Pilar Penuela, M.A.,CCC,SLP

• Neurology Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.