MEDICARE: ANA L INDA MALPICA 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
2	171M00000X	Case Manager/Care Coordinator		FL

General Provider Information

NPI Number	:	1659886737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA L INDA MALPICA RBT

Provider Business Mailing Address
First Line	:	8776 NW 168TH LN
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-6133
Country	:	US
Telephone Number	:	867-803-6343
Fax Number	:

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT STE 313-314
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-7084
Country	:	US
Telephone Number	:	305-825-4320
Fax Number	:

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	10/11/2019

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Directions to “ ANA L INDA MALPICA RBT” Practice Location

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