Provider Demographics
NPI:1316936735
Name:PENATE, ROLANDO (MD)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:PENATE
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 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE C-350
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2539
Mailing Address - Country:US
Mailing Address - Phone:954-731-9676
Mailing Address - Fax:954-731-9747
Practice Address - Street 1:6963 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2803
Practice Address - Country:US
Practice Address - Phone:305-595-3225
Practice Address - Fax:305-595-7812
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055814100Medicaid
E30564Medicare UPIN