MEDICARE: ANISLEIDYS MESA VALDES

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

General Provider Information

NPI Number	:	1932632122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISLEIDYS MESA VALDES

Provider Business Mailing Address
First Line	:	850 W 74TH ST APT 104
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4725
Country	:	US
Telephone Number	:	786-468-3741
Fax Number	:	305-901-1797

Provider Business Practice Location Address
First Line	:	850 W 74TH ST APT 104
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4725
Country	:	US
Telephone Number	:	786-468-3741
Fax Number	:	305-901-1797

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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