Provider Demographics
NPI:1043315781
Name:PENA-ARIET, OLGA (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:PENA-ARIET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13595 ATLANTIC BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3256
Mailing Address - Country:US
Mailing Address - Phone:904-727-5160
Mailing Address - Fax:904-724-0057
Practice Address - Street 1:13595 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3256
Practice Address - Country:US
Practice Address - Phone:904-221-4325
Practice Address - Fax:904-221-9167
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04497OtherBCBS ID#
FL4200425OtherAETNA ID#
FL373312200Medicaid
FL373312200Medicaid