MEDICARE: LEIVYS MOLLEDA PEREZ

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-24-401689	FL

General Provider Information

NPI Number	:	1922818764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIVYS MOLLEDA PEREZ

Provider Business Mailing Address
First Line	:	441 BROWARD AVE
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-2001
Country	:	US
Telephone Number	:	561-379-9713
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 BROWARD AVE
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-2001
Country	:	US
Telephone Number	:	561-379-9713
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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