MEDICARE: MR. ANDREW DANIEL CABANILLAS RBT

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-19-77750	AZ

General Provider Information

NPI Number	:	1013474485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW DANIEL CABANILLAS RBT

Provider Business Mailing Address
First Line	:	10362 E 39TH PL
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-7234
Country	:	US
Telephone Number	:	928-919-3983
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 S 8TH AVE STE C
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7154
Country	:	US
Telephone Number	:	928-782-1338
Fax Number	:

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

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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