MEDICARE: LEIDY VIZCAINO VIERA RBT

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

General Provider Information

NPI Number	:	1548780950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIDY VIZCAINO VIERA RBT

Provider Business Mailing Address
First Line	:	4745 NW 4TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2113
Country	:	US
Telephone Number	:	786-445-9978
Fax Number	:

Provider Business Practice Location Address
First Line	:	4745 NW 4TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2113
Country	:	US
Telephone Number	:	786-445-9978
Fax Number	:

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

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	06/27/2017

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Directions to “ LEIDY VIZCAINO VIERA RBT” Practice Location

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