MEDICARE: MS. ELDA MARIA LEONETTI RBT

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		AZ
2	106S00000X	Behavior Technician	100879
3	106S00000X	Behavior Technician	RBT-19-90373	AZ

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	:	1780264135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELDA MARIA LEONETTI RBT

Provider Business Mailing Address
First Line	:	10103 E DESERT GORGE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5037
Country	:	US
Telephone Number	:	520-488-5387
Fax Number	:

Provider Business Practice Location Address
First Line	:	10103 E DESERT GORGE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5037
Country	:	US
Telephone Number	:	520-488-5387
Fax Number	:

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

Provider Enumeration Date	:	04/10/2021
Last Update Date	:	04/10/2021

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