MEDICARE: MR. RENY ANTHONY SANTIESTEBAN SR.

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-23-259368	FL

General Provider Information

NPI Number	:	1457055295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RENY ANTHONY SANTIESTEBAN SR.

Provider Business Mailing Address
First Line	:	440 E 23RD ST APT 1402
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3940
Country	:	US
Telephone Number	:	786-339-4882
Fax Number	:

Provider Business Practice Location Address
First Line	:	6625 MIAMI LAKES DR STE 338
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2705
Country	:	US
Telephone Number	:	305-777-3852
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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