Provider Demographics
NPI:1548814338
Name:ARENA, JOSE FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
Last Name:ARENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 SW 73RD CT APT 809
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2952
Mailing Address - Country:US
Mailing Address - Phone:240-281-4252
Mailing Address - Fax:
Practice Address - Street 1:9055 SW 73RD CT APT 809
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2952
Practice Address - Country:US
Practice Address - Phone:240-281-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18294207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty