MEDICARE: MS. TATIANA ARENCIBIA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1457922098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TATIANA ARENCIBIA

Provider Business Mailing Address
First Line	:	5755 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-8904
Country	:	US
Telephone Number	:	702-755-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	5755 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-8904
Country	:	US
Telephone Number	:	702-755-7985
Fax Number	:

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

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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