Healthcare Provider Details

I. General information

NPI: 1609506633
Provider Name (Legal Business Name): VICTOR PENA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

820 SKY PINE WAY APT H2
GREENACRES FL
33415-9036
US

V. Phone/Fax

Practice location:
  • Phone: 561-729-6631
  • Fax: 561-771-6630
Mailing address:
  • Phone: 772-222-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: