Healthcare Provider Details

I. General information

NPI: 1316787187
Provider Name (Legal Business Name): LIANYS GARCIA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 LAKE WORTH RD STE A
GREENACRES FL
33463-3001
US

IV. Provider business mailing address

2917 BARD ST
WEST PALM BEACH FL
33406-3605
US

V. Phone/Fax

Practice location:
  • Phone: 561-421-0047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-345229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: