Healthcare Provider Details

I. General information

NPI: 1093339905
Provider Name (Legal Business Name): PEDRO OSNIEL PALENZUELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 W 24TH AVE APT 17
HIALEAH FL
33016-3982
US

IV. Provider business mailing address

6445 W 24TH AVE APT 17
HIALEAH FL
33016-3982
US

V. Phone/Fax

Practice location:
  • Phone: 786-354-2916
  • Fax:
Mailing address:
  • Phone: 786-354-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-120428
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: