Individual
JORGE REQUENA PENENORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1350 HICKORY ST STE 101, MELBOURNE, FL 32901-3224
(321) 361-5674
(321) 676-6434
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 361-5674
(321) 676-6434
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME138352
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103078600
—
FL
01
—
N0906
HF MEDICARE
FL
Enumeration date
03/30/2015
Last updated
09/19/2023
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