MEDICARE: SELENA CONCEPCION

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-20-129014	FL

General Provider Information

NPI Number	:	1285244335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA CONCEPCION

Provider Business Mailing Address
First Line	:	20883 NW 4TH ST
Second Line	:
City	:	PEMBROKE PNES
State	:	FL
Zip	:	33029-2185
Country	:	US
Telephone Number	:	954-662-5863
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W 84TH ST STE 404A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5773
Country	:	US
Telephone Number	:	561-350-8591
Fax Number	:

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

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	11/13/2022

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Directions to “ SELENA CONCEPCION ” Practice Location

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