MEDICARE: ADVANCEABA INC.

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	1-06-2787	FL
2	103K00000X	Behavior Analyst	1-14-15955	CA

General Provider Information

NPI Number	:	1750731808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCEABA INC.

Provider Business Mailing Address
First Line	:	6504 SW 166TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5624
Country	:	US
Telephone Number	:	786-553-0437
Fax Number	:

Provider Business Practice Location Address
First Line	:	6504 SW 166TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5624
Country	:	US
Telephone Number	:	786-553-0437
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. YENDRI DIAZ
Credential	:	B.C.B.A.
Telephone Number	:	786-553-0437

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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Directions to “ADVANCEABA INC. ” Practice Location

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