Provider Demographics
NPI:1841717014
Name:PENA GARCIA, MARTHA AMALIA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:AMALIA
Last Name:PENA GARCIA
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 1:5375 PALM AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2771
Mailing Address - Country:US
Mailing Address - Phone:786-477-0136
Mailing Address - Fax:
Practice Address - Street 1:5375 PALM AVE APT 6
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2771
Practice Address - Country:US
Practice Address - Phone:786-477-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician