MEDICARE: ADRIAN RAMIREZ SARDINAS

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	:	1639916620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN RAMIREZ SARDINAS

Provider Business Mailing Address
First Line	:	1620 BARTRAM RD APT 2308
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 BARTRAM RD APT 2308
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2651
Country	:	US
Telephone Number	:	904-576-6123
Fax Number	:

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

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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