MEDICARE: LILLIAM RODRIGUEZ PRADES

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-21-155830	FL

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	:	1205401163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAM RODRIGUEZ PRADES

Provider Business Mailing Address
First Line	:	16254 SW 95TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-4923
Country	:	US
Telephone Number	:	786-317-9964
Fax Number	:

Provider Business Practice Location Address
First Line	:	16254 SW 95TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-4923
Country	:	US
Telephone Number	:	786-317-9964
Fax Number	:

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	12/21/2021

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Directions to “ LILLIAM RODRIGUEZ PRADES ” Practice Location

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