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Individual

DR. EMMANUEL PENA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
841 PRUDENTIAL DR, SUITE 1130, JACKSONVILLE, FL 32207
(904) 603-4199
(904) 633-4188
Mailing address
841 PRUDENTIAL DR, SUITE 1130, JACKSONVILLE, FL 32207-8329
(904) 603-4199
(904) 633-4188

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
11096A
GA
208000000X
Pediatrics Physician
11096A
WY
208000000X
Pediatrics Physician
OS12734
FL
2080C0008X
Child Abuse Pediatrics Physician
Primary
80622
GA
2080C0008X
Child Abuse Pediatrics Physician
OS12734
FL

Other

Enumeration date
03/29/2011
Last updated
06/07/2018
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