Provider Demographics
NPI:1811712763
Name:PENA RODRIGUEZ, YESSICA LIANET
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:LIANET
Last Name:PENA RODRIGUEZ
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 1:15420 SW 75TH CIRCLE LN APT 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1866
Mailing Address - Country:US
Mailing Address - Phone:786-319-2585
Mailing Address - Fax:
Practice Address - Street 1:15420 SW 75TH CIRCLE LN APT 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1866
Practice Address - Country:US
Practice Address - Phone:786-319-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician