Provider Demographics
NPI:1023717550
Name:PENA, HERMINIA CARIDAD
Entity type:Individual
Prefix:
First Name:HERMINIA
Middle Name:CARIDAD
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 1:12955 SW 186TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3007
Mailing Address - Country:US
Mailing Address - Phone:786-343-1269
Mailing Address - Fax:
Practice Address - Street 1:2898 NW 79TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1033
Practice Address - Country:US
Practice Address - Phone:786-646-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician