MEDICARE: CAMILO ERNESTO MARCAIDA

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	:	1669098877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILO ERNESTO MARCAIDA

Provider Business Mailing Address
First Line	:	3830 NW 79TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8328
Country	:	US
Telephone Number	:	305-747-9337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 NW 79TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8328
Country	:	US
Telephone Number	:	305-747-9337
Fax Number	:

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	06/23/2020

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Directions to “ CAMILO ERNESTO MARCAIDA ” Practice Location

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