MEDICARE: LEYDIS LARRALDE

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	L643520936770	FL

General Provider Information

NPI Number	:	1053159483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEYDIS LARRALDE

Provider Business Mailing Address
First Line	:	5643 HAYES ST # B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5164
Country	:	US
Telephone Number	:	786-858-6402
Fax Number	:

Provider Business Practice Location Address
First Line	:	5643 HAYES ST # B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5164
Country	:	US
Telephone Number	:	786-858-6402
Fax Number	:

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/18/2024

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Directions to “ LEYDIS LARRALDE ” Practice Location

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