MEDICARE: MAIDELIS AVILA

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-24-354351	FL

General Provider Information

NPI Number	:	1225861560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIDELIS AVILA

Provider Business Mailing Address
First Line	:	16321 NW 37TH PL
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6363
Country	:	US
Telephone Number	:	305-491-6970
Fax Number	:

Provider Business Practice Location Address
First Line	:	16321 NW 37TH PL
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6363
Country	:	US
Telephone Number	:	305-491-6970
Fax Number	:

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

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	08/22/2024

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Directions to “ MAIDELIS AVILA ” Practice Location

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