Individual
CARLOS G. PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6705 SW 57TH AVE STE 310, SOUTH MIAMI, FL 33143-3638
(786) 514-6395
Mailing address
6705 SW 57TH AVE STE 310, SOUTH MIAMI, FL 33143-3638
(786) 514-6395
(786) 615-4456
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME96839
FL
207V00000X
Obstetrics & Gynecology Physician
Primary
ME96839
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED FOR
—
FL
01
—
BC BS OF FLORIDA
APPLICATION IN PROCESS
FL
Enumeration date
09/23/2006
Last updated
09/07/2023
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