MEDICARE: MAGALIS TAINELY LEON JORGE

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-20-137159	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003589045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGALIS TAINELY LEON JORGE

Provider Business Mailing Address
First Line	:	4421 NW 191ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2113
Country	:	US
Telephone Number	:	786-712-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	4421 NW 191ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2113
Country	:	US
Telephone Number	:	786-712-0186
Fax Number	:

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	08/10/2021

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Directions to “ MAGALIS TAINELY LEON JORGE ” Practice Location

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