MEDICARE: NAILYN VAZQUEZ MARTINEZ DE VALDIVIELSO

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	23-306301	FL

General Provider Information

NPI Number	:	1336912831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAILYN VAZQUEZ MARTINEZ DE VALDIVIELSO

Provider Business Mailing Address
First Line	:	10540 NW 78TH ST APT 106
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-6080
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 NW 78TH ST
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-6079
Country	:	US
Telephone Number	:	305-360-4704
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	03/12/2026

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Directions to “ NAILYN VAZQUEZ MARTINEZ DE VALDIVIELSO ” Practice Location

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