Provider Demographics
NPI:1073293072
Name:PENA RUIZ, MARIA DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LA CARIDAD
Last Name:PENA RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 SW 82ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7441
Mailing Address - Country:US
Mailing Address - Phone:053-453-2543
Mailing Address - Fax:
Practice Address - Street 1:7323 SW 82ND ST APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7441
Practice Address - Country:US
Practice Address - Phone:053-453-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-282364106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician