MEDICARE: ERNESTO A BAEZ SERPA

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		FL
2	225700000X	Massage Therapist	104852	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	:	1104327600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO A BAEZ SERPA

Provider Business Mailing Address
First Line	:	12340 SW 205TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-5656
Country	:	US
Telephone Number	:	305-519-6424
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 SW 68TH COURT CIR APT 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6871
Country	:	US
Telephone Number	:	305-519-6424
Fax Number	:

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	07/15/2024

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