MEDICARE: LITTLE EINSTEINS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770112666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE EINSTEINS INC

Provider Business Mailing Address
First Line	:	9131 NW 120TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4178
Country	:	US
Telephone Number	:	786-797-0931
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W 84TH ST STE 112
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5771
Country	:	US
Telephone Number	:	786-666-0447
Fax Number	:	305-647-2912

Authorized Official
Title or Position	:	OWNER
Name	:	MS. YENISEYS LAZCANO
Credential	:
Telephone Number	:	305-896-8727

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	04/06/2020

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Directions to “LITTLE EINSTEINS INC ” Practice Location

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