MEDICARE: ELICEO MARTINEZ MEJIAS

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-25-429804	FL

General Provider Information

NPI Number	:	1376331546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELICEO MARTINEZ MEJIAS

Provider Business Mailing Address
First Line	:	3271 NW 171ST TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4256
Country	:	US
Telephone Number	:	561-371-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	3271 NW 171ST TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4256
Country	:	US
Telephone Number	:	561-371-2328
Fax Number	:

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

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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