=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225917040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDIRA SOSA PENA RBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 SW 137TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-0572
-----------------------------------------------------
Fax | 786-980-5700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16128 SW 68TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-992-7122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------