MEDICARE: RONEL MONTERO LAURENCIO

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	23307723	FL

General Provider Information

NPI Number	:	1295503100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONEL MONTERO LAURENCIO

Provider Business Mailing Address
First Line	:	1518 RIVER DR APT E204
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3080
Country	:	US
Telephone Number	:	813-893-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 RIVER DR APT E204
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3080
Country	:	US
Telephone Number	:	813-893-4749
Fax Number	:

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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Directions to “ RONEL MONTERO LAURENCIO ” Practice Location

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