Jorge L Pena, CLINICAL PSYCHOLOGIS

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

PY3600 Issued in FL

Practice address

1825 NW 167TH St
Suite #102
Miami Gardens, FL 33056-4838

Phone

(305) 624-7450

Fax

(305) 623-7893

NPI assigned

Dec 27, 2007

Last updated

Dec 27, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198713600000",
    "number": "1649454679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9225 COLLINS AVENUE",
            "address_2": "APT. #1411",
            "city": "SURFSIDE",
            "state": "FL",
            "postal_code": "33154",
            "telephone_number": "305-442-8692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 NW 167TH ST",
            "address_2": "SUITE #102",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330564838",
            "telephone_number": "305-624-7450",
            "fax_number": "305-623-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "JORGE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "CLINICAL PSYCHOLOGIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-27",
        "last_updated": "2007-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "PY3600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suney Hortensia Pena Corrales
• Beatriz Pena
• Camila Franchesca Pena
• Carlos Antonio Pena, DC
• Christine Pena
• Mislay Pena
• Tania Caridad Pena
• Majel Penalver Aulet
• Penate Adult Daycare 4 LLC
• Penate Medical Center 4 LLC

• Exclusive Provider Organization in Miami Gardens, FL
• Providers in Miami Gardens, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.