MEDICARE: LUZ SARANOVA BACB

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	106E00000X	Assistant Behavior Analyst	0-21-12336	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	:	1336682574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ SARANOVA BACB

Provider Business Mailing Address
First Line	:	8870 FONTAINEBLEAU BLVD APT 202
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-4427
Country	:	US
Telephone Number	:	786-307-6502
Fax Number	:

Provider Business Practice Location Address
First Line	:	8870 FONTAINEBLEAU BLVD APT 202
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-4427
Country	:	US
Telephone Number	:	786-307-6502
Fax Number	:

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

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	07/16/2021

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Directions to “ LUZ SARANOVA BACB” Practice Location

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