MEDICARE: LAIDA MARIN AVILA

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	RBT-23-312977	FL

General Provider Information

NPI Number	:	1790546869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAIDA MARIN AVILA

Provider Business Mailing Address
First Line	:	1127 15TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1870
Country	:	US
Telephone Number	:	239-772-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 15TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1870
Country	:	US
Telephone Number	:	239-772-0062
Fax Number	:

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

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	04/09/2026

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Directions to “ LAIDA MARIN AVILA ” Practice Location

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