MEDICARE: GRETY ONDARZA MEDINA

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-20-148298	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	:	1750001269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETY ONDARZA MEDINA

Provider Business Mailing Address
First Line	:	4844 INDIAN SPRINGS CT
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-3876
Country	:	US
Telephone Number	:	813-585-5594
Fax Number	:

Provider Business Practice Location Address
First Line	:	4844 INDIAN SPRINGS CT
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-3876
Country	:	US
Telephone Number	:	813-585-5594
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	09/02/2022

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