Provider Demographics
NPI:1083476568
Name:PUPO PENA, RACHEL C
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:C
Last Name:PUPO PENA
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 1:1402 N D ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-1761
Mailing Address - Country:US
Mailing Address - Phone:561-460-3098
Mailing Address - Fax:
Practice Address - Street 1:1402 N D ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-1761
Practice Address - Country:US
Practice Address - Phone:561-460-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician