Healthcare Provider Details

I. General information

NPI: 1649926445
Provider Name (Legal Business Name): FATIMA COLOME PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SW 72ND ST STE 131
MIAMI FL
33173-5492
US

IV. Provider business mailing address

15679 SW 73RD CIRCLE TER APT 36
MIAMI FL
33193-1843
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-6448
  • Fax:
Mailing address:
  • Phone: 786-631-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: