MEDICARE: DARY NOEMI CARRERAS BODON

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-22-245151	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730890666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARY NOEMI CARRERAS BODON

Provider Business Mailing Address
First Line	:	2775 10TH AVE N APT 208
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-6753
Country	:	US
Telephone Number	:	787-948-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 10TH AVE N APT 208
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-6753
Country	:	US
Telephone Number	:	787-948-1304
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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