MEDICARE: ARLEN CARBALLO AZCUY

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-24-324948	FL

General Provider Information

NPI Number	:	1205680295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLEN CARBALLO AZCUY

Provider Business Mailing Address
First Line	:	3165 SW 108TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2449
Country	:	US
Telephone Number	:	786-566-1308
Fax Number	:

Provider Business Practice Location Address
First Line	:	3165 SW 108TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2449
Country	:	US
Telephone Number	:	786-566-1308
Fax Number	:

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

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	09/19/2024

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Directions to “ ARLEN CARBALLO AZCUY ” Practice Location

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