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General NPI Number Information
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NPI Number | 1942646070
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Entity Type | Organization
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Legal Business Name | KARLA D PENA ROSA PHD LLC
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 412 S HART BLVD
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City | ORLANDO
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State | FL
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Zip | 32835-1950
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Country | US
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Telephone | 321-246-7490
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Fax |
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Provider Business Mailing Address
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Address Line | 412 S HART BLVD
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City | ORLANDO
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State | FL
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Zip | 32835-1950
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Country | US
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Telephone | 321-246-7490
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. KARLA DANIELLE PENA ROSA
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Credential | PH.D.
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Telephone | 321-246-7490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 8755
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License Number State | FL
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