MEDICARE: TACORONTE THERAPY SERVICES LLC

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

General Provider Information

NPI Number	:	1184372849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TACORONTE THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	7108 SW 103RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1377
Country	:	US
Telephone Number	:	305-930-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	7108 SW 103RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1377
Country	:	US
Telephone Number	:	305-930-9811
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANET MARTINEZ TACORONTE
Credential	:	MS, BCBA
Telephone Number	:	305-930-9811

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	03/12/2022

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