MEDICARE: MADELEN MOREJON MADRAZO

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	103K00000X	Behavior Analyst	1-23-69881	FL

General Provider Information

NPI Number	:	1366198665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEN MOREJON MADRAZO

Provider Business Mailing Address
First Line	:	904 NW 31ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3928
Country	:	US
Telephone Number	:	305-200-7082
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 NW 31ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3928
Country	:	US
Telephone Number	:	305-200-7082
Fax Number	:

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

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	03/24/2026

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