MEDICARE: IBETH LA PENA TORRES

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	RBT20121711	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730836008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBETH LA PENA TORRES

Provider Business Mailing Address
First Line	:	7080 W 35TH AVE UNIT 111
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-7111
Country	:	US
Telephone Number	:	786-602-9390
Fax Number	:

Provider Business Practice Location Address
First Line	:	7080 W 35TH AVE UNIT 111
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-7111
Country	:	US
Telephone Number	:	786-602-9390
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/25/2022

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Directions to “ IBETH LA PENA TORRES ” Practice Location

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