Provider Demographics
NPI:1861242992
Name:PENA BIENTZ, MARIA VICTORIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:PENA BIENTZ
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 1:801 NW 47TH AVE APT W303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2561
Mailing Address - Country:US
Mailing Address - Phone:786-695-5398
Mailing Address - Fax:
Practice Address - Street 1:801 NW 47TH AVE APT W303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2561
Practice Address - Country:US
Practice Address - Phone:786-695-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-335067106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician