MEDICARE: LEYMIS ECHEMENDIA VIGUERA

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	106E00000X	Assistant Behavior Analyst	0-20-10848	FL
2	106S00000X	Behavior Technician	19-91487	FL
3	103K00000X	Behavior Analyst	1-21-50466	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528611423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEYMIS ECHEMENDIA VIGUERA

Provider Business Mailing Address
First Line	:	1606 SW 6TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3420
Country	:	US
Telephone Number	:	305-742-8829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 SW 6TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3420
Country	:	US
Telephone Number	:	305-742-8829
Fax Number	:

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

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	06/11/2021

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