Provider Demographics
NPI:1396526760
Name:PENA PEREZ, ASTRID ELENA (MS)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:ELENA
Last Name:PENA PEREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 NW 89TH ST APT 225
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1786
Mailing Address - Country:US
Mailing Address - Phone:786-294-3591
Mailing Address - Fax:
Practice Address - Street 1:790 NW 107TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3100
Practice Address - Country:US
Practice Address - Phone:305-964-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health