Healthcare Provider Details

I. General information

NPI: 1801735295
Provider Name (Legal Business Name): EMILIO GABRIEL PENA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 WARRENTON WAY
COLORADO SPRINGS CO
80922-1370
US

IV. Provider business mailing address

2890 WARRENTON WAY
COLORADO SPRINGS CO
80922-1370
US

V. Phone/Fax

Practice location:
  • Phone: 515-520-2197
  • Fax:
Mailing address:
  • Phone: 515-520-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: