Provider Demographics
NPI:1346893146
Name:PENA, ARTIANI M
Entity Type:Individual
Prefix:MS
First Name:ARTIANI
Middle Name:M
Last Name: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 1:12122 NE 11TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5823
Mailing Address - Country:US
Mailing Address - Phone:786-389-7765
Mailing Address - Fax:
Practice Address - Street 1:290 NE 151ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-5010
Practice Address - Country:US
Practice Address - Phone:786-389-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP500013987460106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician