MEDICARE: RADIBELKYS LEONARDO BAEZ DE NUNEZ

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-24-341634	FL

General Provider Information

NPI Number	:	1730928680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADIBELKYS LEONARDO BAEZ DE NUNEZ

Provider Business Mailing Address
First Line	:	1 GLEN ROYAL PKWY APT 1412
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GLEN ROYAL PKWY APT 1412
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5291
Country	:	US
Telephone Number	:	978-416-1736
Fax Number	:

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	09/10/2024

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