Healthcare Provider Details

I. General information

NPI: 1023717550
Provider Name (Legal Business Name): HERMINIA CARIDAD PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 NW 79TH AVE
DORAL FL
33122-1033
US

IV. Provider business mailing address

12955 SW 186TH TER
MIAMI FL
33177-3007
US

V. Phone/Fax

Practice location:
  • Phone: 786-646-9097
  • Fax:
Mailing address:
  • Phone: 786-343-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: