MEDICARE: DEL RIO HEALTH LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1346075298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL RIO HEALTH LLC

Provider Business Mailing Address
First Line	:	2328 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6606
Country	:	US
Telephone Number	:	786-828-4884
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MACIEL RODRIGUEZ JIMENEZ
Credential	:
Telephone Number	:	786-828-4884

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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