MEDICARE: MARILE ACHOY BERNAL

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		FL

General Provider Information

NPI Number	:	1588395917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILE ACHOY BERNAL

Provider Business Mailing Address
First Line	:	4528 W IDLEWILD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4528 W IDLEWILD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5438
Country	:	US
Telephone Number	:	813-454-3169
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	08/25/2022

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