Provider Demographics
NPI:1831870856
Name:PENA, MARCO AURELIO
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:AURELIO
Last Name:PENA
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 1:9400 SW 222ND LN
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1467
Mailing Address - Country:US
Mailing Address - Phone:786-678-7927
Mailing Address - Fax:
Practice Address - Street 1:9400 SW 222ND LN
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1467
Practice Address - Country:US
Practice Address - Phone:786-678-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician