Provider Demographics
NPI:1548936651
Name:PENA GUTIERREZ, LILIANA (RBT)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:PENA GUTIERREZ
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 1:223 CREEKSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-9006
Mailing Address - Country:US
Mailing Address - Phone:407-773-5833
Mailing Address - Fax:
Practice Address - Street 1:223 CREEKSIDE WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-9006
Practice Address - Country:US
Practice Address - Phone:407-773-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician