MEDICARE: ANGELO JOSE ROMERO SIMO RBT

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	20-143203	FL

General Provider Information

NPI Number	:	1225813827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELO JOSE ROMERO SIMO RBT

Provider Business Mailing Address
First Line	:	24634 SW 115TH CT
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-4712
Country	:	US
Telephone Number	:	305-457-5467
Fax Number	:

Provider Business Practice Location Address
First Line	:	24634 SW 115TH CT
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-4712
Country	:	US
Telephone Number	:	305-457-5467
Fax Number	:

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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