Healthcare Provider Details

I. General information

NPI: 1346753431
Provider Name (Legal Business Name): YULEYDIS PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 FETROW DR
ORLANDO FL
32812-8008
US

IV. Provider business mailing address

4330 FETROW DR
ORLANDO FL
32812-8008
US

V. Phone/Fax

Practice location:
  • Phone: 786-201-0069
  • Fax:
Mailing address:
  • Phone: 786-201-0069
  • 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: