MEDICARE: LIDICES MORA RAMOS

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	:	1558225128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDICES MORA RAMOS

Provider Business Mailing Address
First Line	:	1441 NW 19TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1584
Country	:	US
Telephone Number	:	786-890-4583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 NW 19TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1584
Country	:	US
Telephone Number	:	786-890-4583
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ LIDICES MORA RAMOS ” Practice Location

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