Penstar Provider Network LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PENSTAR PROVIDER NETWORK LLC

Practice address

1931 NW 150TH Ave Ste 228
Pembroke Pines, FL 33028-2880

Phone

(754) 226-6456

NPI assigned

Nov 11, 2020

Organization subpart

No

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

Authorized official

Name

Ileana Villarreal

Title

MGR

Phone

(954) 281-5022

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605052800000",
    "number": "1912509233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1931 NW 150TH AVE STE 228",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330282880",
            "telephone_number": "754-226-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 NW 150TH AVE STE 228",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330282880",
            "telephone_number": "754-226-6456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSTAR PROVIDER NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-11",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A",
        "authorized_official_last_name": "VILLARREAL",
        "authorized_official_first_name": "ILEANA",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "954-281-5022"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Antonio Pena, D.M.D.
• Ronoel Penalver, M.D
• Elizabeth Carmen Penela, PH.D.
• Youmeizi Peng
• Isabella Penso Mota, RD, LDN
• Mythili Penugonda, MD
• Peony Home Aide Agency LLC
• People Empowering People, PA
• Cindy Pepin, FNP
• Junior Manuel Peralta Pena, NURSE PRACTITIONER

• Specialist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; 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.