Provider Demographics
NPI:1255055224
Name:PENA CORDERO, AYMEE DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:AYMEE
Middle Name:DE LA CARIDAD
Last Name:PENA CORDERO
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 1:25900 SW 143RD CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8947
Mailing Address - Country:US
Mailing Address - Phone:502-656-9086
Mailing Address - Fax:
Practice Address - Street 1:25900 SW 143RD CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8947
Practice Address - Country:US
Practice Address - Phone:502-656-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-230866106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician