MEDICARE: NICOLAS JAMES SIERRA 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-23-267597	FL

General Provider Information

NPI Number	:	1134815475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS JAMES SIERRA RBT

Provider Business Mailing Address
First Line	:	12253 SW 32ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2236
Country	:	US
Telephone Number	:	305-761-2025
Fax Number	:

Provider Business Practice Location Address
First Line	:	9102 NW 148TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-7314
Country	:	US
Telephone Number	:	305-761-2025
Fax Number	:

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

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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