MEDICARE: LEGNA PETITON CARRION

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		FL
2	225A00000X	Music Therapist		FL

General Provider Information

NPI Number	:	1790658144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEGNA PETITON CARRION

Provider Business Mailing Address
First Line	:	6190 W 19TH AVE APT 215
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6075
Country	:	US
Telephone Number	:	786-992-4487
Fax Number	:

Provider Business Practice Location Address
First Line	:	6190 W 19TH AVE APT 215
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6075
Country	:	US
Telephone Number	:	786-992-4487
Fax Number	:

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

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	01/02/2026

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Directions to “ LEGNA PETITON CARRION ” Practice Location

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