MEDICARE: TANIA GUDIN CBHCMS

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	104100000X	Social Worker	CBHCMS100567	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	:	1649760570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA GUDIN CBHCMS

Provider Business Mailing Address
First Line	:	4118 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4107
Country	:	US
Telephone Number	:	305-824-8787
Fax Number	:	305-824-8774

Provider Business Practice Location Address
First Line	:	4118 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4107
Country	:	US
Telephone Number	:	305-824-8787
Fax Number	:	305-824-8774

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

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	05/16/2018

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