MEDICARE: MARISOL SALGADO GUTIERREZ

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
2	106E00000X	Assistant 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	:	1770930414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL SALGADO GUTIERREZ

Provider Business Mailing Address
First Line	:	6429 COW PEN RD APT U213
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6620
Country	:	US
Telephone Number	:	786-597-6625
Fax Number	:

Provider Business Practice Location Address
First Line	:	11645 NW 91ST PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4159
Country	:	US
Telephone Number	:	786-597-6625
Fax Number	:

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	12/07/2021

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