MEDICARE: ALAN LUIS PENA FRANCISCO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1417724840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN LUIS PENA FRANCISCO

Provider Business Mailing Address
First Line	:	5508 CANNON WAY APT F
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-3788
Country	:	US
Telephone Number	:	561-493-4745
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 CANNON WAY APT F
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-3788
Country	:	US
Telephone Number	:	561-493-4745
Fax Number	:

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

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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