MEDICARE: ROSMERY RODRIGUEZ RUIZ I

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	R362720928071	FL

General Provider Information

NPI Number	:	1134971666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSMERY RODRIGUEZ RUIZ I

Provider Business Mailing Address
First Line	:	9362 NW 120TH ST APT 627
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4189
Country	:	US
Telephone Number	:	305-742-4632
Fax Number	:

Provider Business Practice Location Address
First Line	:	9362 NW 120TH ST APT 627
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4189
Country	:	US
Telephone Number	:	305-742-4632
Fax Number	:

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

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/15/2024

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