MEDICARE: SANDRA I MARZO BAEZ

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		FL

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	:	1780376392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA I MARZO BAEZ

Provider Business Mailing Address
First Line	:	45 W 25TH ST APT 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7711 N MILITARY TRL # 1018
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33410-6506
Country	:	US
Telephone Number	:	561-460-0284
Fax Number	:

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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Directions to “ SANDRA I MARZO BAEZ ” Practice Location

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