Provider Demographics
NPI:1982354478
Name:PENA LABRADA, ANA IRIS
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:IRIS
Last Name:PENA LABRADA
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 1:7440 MIAMI LAKES DR APT F211
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6839
Mailing Address - Country:US
Mailing Address - Phone:786-907-7982
Mailing Address - Fax:
Practice Address - Street 1:7440 MIAMI LAKES DR APT F211
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6839
Practice Address - Country:US
Practice Address - Phone:786-907-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-199373106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112798000Medicaid