MEDICARE: ROSALILY MAYORQUIN

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

General Provider Information

NPI Number	:	1548917743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALILY MAYORQUIN

Provider Business Mailing Address
First Line	:	990 HIGHLAND DR STE 310
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2438
Country	:	US
Telephone Number	:	619-961-2015
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 HIGHLAND DR STE 310
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2438
Country	:	US
Telephone Number	:	619-961-2015
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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Directions to “ ROSALILY MAYORQUIN ” Practice Location

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