Provider Demographics
NPI:1053119271
Name:PENNELLA BARRAZA, ISMELDA
Entity type:Individual
Prefix:
First Name:ISMELDA
Middle Name:
Last Name:PENNELLA BARRAZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4244
Mailing Address - Country:US
Mailing Address - Phone:786-682-1333
Mailing Address - Fax:
Practice Address - Street 1:650 NE 32ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4244
Practice Address - Country:US
Practice Address - Phone:786-682-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician