MEDICARE: ALLISON BALDOMERO

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194425991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON BALDOMERO

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PARKWAY
Second Line	:	SUITE 200
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3625
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 W NASA BLVD
Second Line	:	UNIT C-1
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3290
Country	:	US
Telephone Number	:	321-235-6199
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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Directions to “ ALLISON BALDOMERO ” Practice Location

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