MEDICARE: MIDORYS VIVIAN ROCHE SALAZAR

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-25-487634	FL

General Provider Information

NPI Number	:	1699624817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIDORYS VIVIAN ROCHE SALAZAR

Provider Business Mailing Address
First Line	:	11050 SW 197TH ST APT 202
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-8478
Country	:	US
Telephone Number	:	305-784-0039
Fax Number	:

Provider Business Practice Location Address
First Line	:	11050 SW 197TH ST APT 202
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-8478
Country	:	US
Telephone Number	:	305-784-0039
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	04/24/2026

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Directions to “ MIDORYS VIVIAN ROCHE SALAZAR ” Practice Location

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