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NPI Code Detail

MEDICARE: ODALIS MARIA CANCIO LORENZO

MEDICARE:   ODALIS MARIA CANCIO LORENZO
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
1106S00000XBehavior TechnicianRBT-23-299066FL

General Provider Information

NPI Number : 1780458190
Entity Type Code : Individual
Provider Name (Legal Business Name) : ODALIS MARIA CANCIO LORENZO
Provider Business Mailing Address
First Line : 7797 W 29TH LN APT 201
Second Line :
City : HIALEAH
State : FL
Zip : 33018-5189
Country : US
Telephone Number : 786-538-9459
Fax Number :
Provider Business Practice Location Address
First Line : 7797 W 29TH LN APT 201
Second Line :
City : HIALEAH
State : FL
Zip : 33018-5189
Country : US
Telephone Number : 786-538-9459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2023
Last Update Date : 11/07/2023

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Directions to “ ODALIS MARIA CANCIO LORENZO ” Practice Location

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