Provider Demographics
NPI:1053341214
Name:PENATE-PEREZ, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:PENATE-PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SW 117TH AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1428
Mailing Address - Country:US
Mailing Address - Phone:305-596-7432
Mailing Address - Fax:888-715-1420
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-596-7432
Practice Address - Fax:888-715-1420
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine