MEDICARE: ANTHONY WONG PENA

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
1	171M00000X	Case Manager/Care Coordinator	CBHCM103563	FL
2	103K00000X	Behavior Analyst	1-26-88222	FL

General Provider Information

NPI Number	:	1932865854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY WONG PENA

Provider Business Mailing Address
First Line	:	5741 W 20TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2661
Country	:	US
Telephone Number	:	786-626-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 W 20TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2661
Country	:	US
Telephone Number	:	786-626-4106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	03/09/2026

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Directions to “ ANTHONY WONG PENA ” Practice Location

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