Provider Demographics
NPI:1225871403
Name:ALEXIS PENA, LAIZ (RBT)
Entity type:Individual
Prefix:
First Name:LAIZ
Middle Name:
Last Name:ALEXIS PENA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 SW 3RD AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4271
Mailing Address - Country:US
Mailing Address - Phone:954-895-3926
Mailing Address - Fax:
Practice Address - Street 1:12456 SW 127TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6596
Practice Address - Country:US
Practice Address - Phone:305-382-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352646106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician