MEDICARE: FLOR A MEDINA

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	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician	RBT-16-16606	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	:	1134579790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLOR A MEDINA

Provider Business Mailing Address
First Line	:	4575 SE DIXIE HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-6826
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 INDIAN RIVER BLVD
Second Line	:	A210
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5639
Country	:	US
Telephone Number	:	772-774-8275
Fax Number	:

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

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	07/21/2022

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Directions to “ FLOR A MEDINA ” Practice Location

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