Provider Information for 1700070802
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EDGAR ALFONSO PENA L.M.H.C, CAP
Sex: Male
NPI: 1700070802
Last Updated: 2013-02-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1700070802 | ||||||||||||
| Enumeration Date | 2007-08-31 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1470 NE 123 ST #1212 MIAMI, FL 33161 United States Phone: 786-223-3334 | Fax:305-766-8064 | ||||||||||||
| Primary Practice Address | 1354 WASHINGTON AVE STE 221 MIAMI BEACH, FL 33139-4203 United States Phone: 786-223-3334 | Fax:305-766-8064 | ||||||||||||
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