MEDICARE: RAUL CARRILLO RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-492558	FL

General Provider Information

NPI Number	:	1003770090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUL CARRILLO RODRIGUEZ

Provider Business Mailing Address
First Line	:	2712 BARNARD RD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13911 N DALE MABRY HWY STE 108
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2414
Country	:	US
Telephone Number	:	813-784-3619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ RAUL CARRILLO RODRIGUEZ ” Practice Location

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