MEDICARE: LIZ SHENALITH ACEVEDO RUIZ

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-23-258859	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	:	1528768249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZ SHENALITH ACEVEDO RUIZ

Provider Business Mailing Address
First Line	:	1113 SW 78TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4307
Country	:	US
Telephone Number	:	305-804-1401
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 SW 76TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2669
Country	:	US
Telephone Number	:	305-514-5100
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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