MEDICARE: ROSENDO MUNIZ SOTO

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

General Provider Information

NPI Number	:	1770005159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSENDO MUNIZ SOTO

Provider Business Mailing Address
First Line	:	4536 SW 136TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4536 SW 136TH PLACE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175
Country	:	US
Telephone Number	:	786-380-8011
Fax Number	:

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

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/07/2017

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Directions to “ ROSENDO MUNIZ SOTO ” Practice Location

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