MEDICARE: CAMERON 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	106S00000X	Behavior Technician	RBT-25-487624	AZ

General Provider Information

NPI Number	:	1992668768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON PENA

Provider Business Mailing Address
First Line	:	330 E ROOSEVELT ST APT 5048
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-4314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 E ROOSEVELT ST APT 5048
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-4314
Country	:	US
Telephone Number	:	480-995-1570
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ CAMERON PENA ” Practice Location

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