MEDICARE: SOONER T ORTIZ ROSARIO

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-19-87552	FL

General Provider Information

NPI Number	:	1730748393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOONER T ORTIZ ROSARIO

Provider Business Mailing Address
First Line	:	9875 ALTIS CIR W UNIT 8204
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-6095
Country	:	US
Telephone Number	:	786-812-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	9960 ALTIS CIR W UNIT 4202
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-6099
Country	:	US
Telephone Number	:	786-812-9016
Fax Number	:

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

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	03/13/2023

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Directions to “ SOONER T ORTIZ ROSARIO ” Practice Location

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