=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093425373
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEMARY GUERRERO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2022
-----------------------------------------------------
Last Update Date | 11/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 NW 62ND ST STE D110
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-1770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-909-5953
-----------------------------------------------------
Fax | 954-909-5953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5913 NW 46TH TER
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-2745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-918-2522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-22-244871
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------