Individual
DR. JORGE L PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CLINICAL PSYCHOLOGIS
Contact information
Practice address
1825 NW 167TH ST, SUITE #102, MIAMI GARDENS, FL 33056-4838
(305) 624-7450
(305) 623-7893
Mailing address
9225 COLLINS AVENUE, APT. #1411, SURFSIDE, FL 33154
(305) 442-8692
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
PY3600
FL
Other
Enumeration date
12/27/2007
Last updated
12/27/2007
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