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General NPI Number Information
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NPI Number | 1033851845
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Entity Type | Individual
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Provider Name | MAYRETH GONZALEZ PENA RN, CBHCMS
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 14505 COMMERCE WAY STE 750
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City | MIAMI LAKES
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State | FL
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Zip | 33016-1514
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Country | US
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Telephone | 305-362-9989
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Fax |
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Provider Business Mailing Address
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Address Line | 8306 COMMERCE WAY APT 241
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City | MIAMI LAKES
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State | FL
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Zip | 33016-1610
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Country | US
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Telephone | 786-398-1366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CBHCMS101245
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License Number State | FL
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