Healthcare Provider Details

I. General information

NPI: 1326495367
Provider Name (Legal Business Name): ORALYS PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19481 NW 60TH CT
HIALEAH FL
33015-4833
US

IV. Provider business mailing address

19481 NW 60TH CT
HIALEAH FL
33015-4833
US

V. Phone/Fax

Practice location:
  • Phone: 786-426-0682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: