MEDICARE: RUBEN SANTIESTEBAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S532720950230	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1093220394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN SANTIESTEBAN

Provider Business Mailing Address
First Line	:	7820 RALEIGH ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2532
Country	:	US
Telephone Number	:	305-256-1653
Fax Number	:	305-256-1663

Provider Business Practice Location Address
First Line	:	7820 RALEIGH ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2532
Country	:	US
Telephone Number	:	305-256-1653
Fax Number	:	305-256-1663

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

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	12/08/2017

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Directions to “ RUBEN SANTIESTEBAN ” Practice Location

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