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General NPI Number Information
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NPI Number | 1043992753
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Entity Type | Individual
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Provider Name | GRETTEL BARBARA RODRIGUEZ PENA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 7376 LAKE WORTH RD
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City | GREENACRES
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State | FL
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Zip | 33467-2529
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Country | US
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Telephone | 561-788-4086
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Fax |
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Provider Business Mailing Address
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Address Line | 355 LAKE ARBOR DR
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2155
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Country | US
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Telephone | 561-385-2688
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-80672
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License Number State | FL
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