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General NPI Number Information
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NPI Number | 1497319925
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Entity Type | Individual
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Provider Name | RICARDO DE LA PENA RBT
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Gender | Male
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 7631 PONDEROSA PNE
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City | BOERNE
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State | TX
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Zip | 78015-5141
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Country | US
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Telephone | 956-266-1205
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Fax | 210-941-0723
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Provider Business Mailing Address
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Address Line | 7631 PONDEROSA PNE
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City | BOERNE
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State | TX
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Zip | 78015-5141
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Country | US
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Telephone | 956-266-1205
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-16-15938
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 5336
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License Number State | TX
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