MEDICARE: ANDIELA VANESA CABRERA BETANCOURT

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	RBT-24-399836	FL

General Provider Information

NPI Number	:	1730994096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDIELA VANESA CABRERA BETANCOURT

Provider Business Mailing Address
First Line	:	14921 SW 80TH ST APT 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14921 SW 80TH ST APT 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3153
Country	:	US
Telephone Number	:	786-849-5273
Fax Number	:

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

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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