Provider Demographics
NPI:1336988898
Name:PENA GARCIA, DAIDEE
Entity type:Individual
Prefix:
First Name:DAIDEE
Middle Name:
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 1:1434 KIRK ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-785-7103
Mailing Address - Fax:
Practice Address - Street 1:1434 KIRK ROAD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-785-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-346983106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician