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NPI Code Detail

MEDICARE: HERNANDO PENA JR.

MEDICARE: HERNANDO PENA JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-23-261415FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720789951
Entity Type Code : Individual
Provider Name (Legal Business Name) : HERNANDO PENA JR.
Provider Business Mailing Address
First Line : 1115 WESLEY ST W
Second Line :
City : LEHIGH ACRES
State : FL
Zip : 33936-6509
Country : US
Telephone Number : 786-416-2014
Fax Number :
Provider Business Practice Location Address
First Line : 1219 SE 34TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-4291
Country : US
Telephone Number : 239-703-3502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2023
Last Update Date : 03/14/2023

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