MEDICARE: FABIOLA ANDREA BERROCAL CCC-SLP

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	235Z00000X	Speech-Language Pathologist	20830	FL

General Provider Information

NPI Number	:	1356068712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIOLA ANDREA BERROCAL CCC-SLP

Provider Business Mailing Address
First Line	:	2145 NE 164TH ST APT 644
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4292
Country	:	US
Telephone Number	:	939-640-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 NE 164TH ST APT 644
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4292
Country	:	US
Telephone Number	:	939-640-2215
Fax Number	:

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

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	10/25/2022

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