Provider Demographics
NPI:1861151169
Name:CORDOVA PENAYOS, BARBARA PATRICIA (RBT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:PATRICIA
Last Name:CORDOVA PENAYOS
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 1:3020 NW 87TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3748
Mailing Address - Country:US
Mailing Address - Phone:786-387-5847
Mailing Address - Fax:
Practice Address - Street 1:3020 NW 87TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3748
Practice Address - Country:US
Practice Address - Phone:786-387-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20145736106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician