Provider Demographics
NPI:1497339261
Name:PENA CUESTA, PEDRO JR
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:PENA CUESTA
Suffix:JR
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 1:7619 COOT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7705
Mailing Address - Country:US
Mailing Address - Phone:786-238-5632
Mailing Address - Fax:
Practice Address - Street 1:7619 COOT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-7705
Practice Address - Country:US
Practice Address - Phone:786-238-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool