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NPI Code Detail

MEDICARE: DE ANNI MARIE GROSSARTH

MEDICARE: DE ANNI MARIE GROSSARTH
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
1106S00000XBehavior TechnicianRBT-25-479220FL

General Provider Information

NPI Number : 1053276055
Entity Type Code : Individual
Provider Name (Legal Business Name) : DE ANNI MARIE GROSSARTH
Provider Business Mailing Address
First Line : 777 NW 72ND AVE STE 1083
Second Line :
City : MIAMI
State : FL
Zip : 33126-3176
Country : US
Telephone Number : 786-490-6307
Fax Number :
Provider Business Practice Location Address
First Line : 777 NW 72ND AVE STE 1083
Second Line :
City : MIAMI
State : FL
Zip : 33126-3176
Country : US
Telephone Number : 786-490-6307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2025
Last Update Date : 12/22/2025

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Directions to “ DE ANNI MARIE GROSSARTH ” Practice Location

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