Provider Demographics
NPI:1306489927
Name:HENAO-PENA, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:HENAO-PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:HENAO-RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-2480
Mailing Address - Fax:718-334-2478
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2480
Practice Address - Fax:718-334-2478
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115347363A00000X, 363A00000X
NY024683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
I8ANIOtherBLUE CROSS BLUE SHIELD
FL114510700Medicaid