MEDICARE: DANIEL A PENA GUTIERREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	RBT-25-492394	FL

General Provider Information

NPI Number	:	1013876408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL A PENA GUTIERREZ

Provider Business Mailing Address
First Line	:	1191 E NEWPORT CENTER DR
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7715
Country	:	US
Telephone Number	:	954-644-0682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1191 E NEWPORT CENTER DR
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7715
Country	:	US
Telephone Number	:	954-644-0682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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