MEDICARE: ANA MARY COTO ROQUE

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	24-320025	FL

General Provider Information

NPI Number	:	1760253553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA MARY COTO ROQUE

Provider Business Mailing Address
First Line	:	7140 NW 179TH ST APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5432
Country	:	US
Telephone Number	:	786-909-5744
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 NW 179TH ST APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5432
Country	:	US
Telephone Number	:	786-909-5744
Fax Number	:

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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Directions to “ ANA MARY COTO ROQUE ” Practice Location

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