MEDICARE: ROYALTY 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	:	1235837568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYALTY THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	6750 N ANDREWS AVE # 2021
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	786-597-8543
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 N ANDREWS AVE # 2021
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	786-597-8543
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSET THALIA GONZALEZ DUQUE
Credential	:
Telephone Number	:	786-597-8543

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	05/02/2023

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