MEDICARE: NICOLE GALLEGO BERRIOS

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	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1740174507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE GALLEGO BERRIOS

Provider Business Mailing Address
First Line	:	477 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	786-306-1985
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	786-306-1985
Fax Number	:

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

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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