MEDICARE: MENA RBT 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1184450884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENA RBT LLC

Provider Business Mailing Address
First Line	:	6245 SW KENDALE LAKES CIR APT 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-1961
Country	:	US
Telephone Number	:	786-782-1343
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 SW KENDALE LAKES CIR APT 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-1961
Country	:	US
Telephone Number	:	786-782-1343
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LUIS A MENA GARCIA
Credential	:
Telephone Number	:	786-782-1343

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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