Provider Demographics
NPI:1205669256
Name:PENA SORIANO, LAURA VALENTINA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:VALENTINA
Last Name:PENA SORIANO
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 1:5333 SCORIA TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-3924
Mailing Address - Country:US
Mailing Address - Phone:210-422-8242
Mailing Address - Fax:
Practice Address - Street 1:5616 LONE STAR PKWY STE 101&102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2200
Practice Address - Country:US
Practice Address - Phone:121-020-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician