MEDICARE: ILIANYS POUZA BERROA

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-26-533679	FL

General Provider Information

NPI Number	:	1427980861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIANYS POUZA BERROA

Provider Business Mailing Address
First Line	:	1551 EVALENA LN
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-4176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 SANTA BARBARA BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-8039
Country	:	US
Telephone Number	:	239-422-6031
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ ILIANYS POUZA BERROA ” Practice Location

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