Provider Demographics
NPI:1467000778
Name:DE LA PENA BARRIOS, CARLOS FELIX
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:FELIX
Last Name:DE LA PENA BARRIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5040
Mailing Address - Country:US
Mailing Address - Phone:786-260-4014
Mailing Address - Fax:
Practice Address - Street 1:68 ESSEX AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5040
Practice Address - Country:US
Practice Address - Phone:786-260-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician