MEDICARE: KAIYA YI PENA

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		AZ

General Provider Information

NPI Number	:	1457293979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIYA YI PENA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	866-611-1558

Provider Business Practice Location Address
First Line	:	6369 E TANQUE VERDE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3850
Country	:	US
Telephone Number	:	855-824-5669
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ KAIYA YI PENA ” Practice Location

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