Provider Demographics
NPI:1811414279
Name:PENALVER AULET, MAJEL
Entity Type:Individual
Prefix:
First Name:MAJEL
Middle Name:
Last Name:PENALVER AULET
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 1:5990 NW 186TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8042
Mailing Address - Country:US
Mailing Address - Phone:786-366-7318
Mailing Address - Fax:
Practice Address - Street 1:5990 NW 186TH ST APT 205
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-8042
Practice Address - Country:US
Practice Address - Phone:786-366-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-69485106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022106700Medicaid