Provider Demographics
NPI:1962751784
Name:PENALES, CHULOU HITOSIS (MD)
Entity type:Individual
Prefix:DR
First Name:CHULOU
Middle Name:HITOSIS
Last Name:PENALES
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 1:5476 QUEENSHIP CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5969
Mailing Address - Country:US
Mailing Address - Phone:719-406-2133
Mailing Address - Fax:561-450-6716
Practice Address - Street 1:13001 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9203
Practice Address - Country:US
Practice Address - Phone:877-832-2652
Practice Address - Fax:800-792-9021
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9295519163W00000X
FLARNP 9295519363LA2100X
390200000X
FLME163843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program