Healthcare Provider Details

I. General information

NPI: 1760324784
Provider Name (Legal Business Name): JUDITH DE LA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 MONACO ST
CORAL GABLES FL
33143-6433
US

IV. Provider business mailing address

7444 MONACO ST
CORAL GABLES FL
33143-6433
US

V. Phone/Fax

Practice location:
  • Phone: 786-424-0879
  • Fax:
Mailing address:
  • Phone: 786-424-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-470345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: