Provider Demographics
NPI:1386108447
Name:PENA, LAURA MAGALY
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MAGALY
Last Name:PENA
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 1:6730 GAILAN RNCH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4577
Mailing Address - Country:US
Mailing Address - Phone:956-251-9501
Mailing Address - Fax:
Practice Address - Street 1:501 W CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4415
Practice Address - Country:US
Practice Address - Phone:210-458-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-45674OtherBEHAVIOR ANALYST CERTIFICATION BOARD
BACB387517OtherBACB