MEDICARE: NAOMI CRUZ MENDEZ 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	RBT-21-187974	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245993914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI CRUZ MENDEZ RBT

Provider Business Mailing Address
First Line	:	4206 EASTGATE DR APT 1407
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-2845
Country	:	US
Telephone Number	:	646-479-4649
Fax Number	:

Provider Business Practice Location Address
First Line	:	4206 EASTGATE DR APT 1407
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-2845
Country	:	US
Telephone Number	:	646-479-4649
Fax Number	:

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

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	01/20/2022

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