MEDICARE: SUSANA M VALDESPINO

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-15-09645

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15-09645	OTHER		BEHAVIOR ANALYST CETIFICATION BOARD

General Provider Information

NPI Number	:	1831635804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA M VALDESPINO

Provider Business Mailing Address
First Line	:	6326 SW 139TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-1179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6326 SW 139TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-1179
Country	:	US
Telephone Number	:	786-523-8182
Fax Number	:

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

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	03/30/2018

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Directions to “ SUSANA M VALDESPINO ” Practice Location

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