MEDICARE: HILDA LORENA LARDOEYT SAMON

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	24-369165	FL

General Provider Information

NPI Number	:	1134953649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILDA LORENA LARDOEYT SAMON

Provider Business Mailing Address
First Line	:	10450 NW 21ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-1377
Country	:	US
Telephone Number	:	786-893-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 S PINE ISLAND RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2669
Country	:	US
Telephone Number	:	754-779-0656
Fax Number	:

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

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	09/19/2024

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