MEDICARE: YENISLEIDYS ROMEU BETANCOURT

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-23-318433	FL

General Provider Information

NPI Number	:	1912778127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENISLEIDYS ROMEU BETANCOURT

Provider Business Mailing Address
First Line	:	6912 SW 127TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6912 SW 127TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2404
Country	:	US
Telephone Number	:	954-646-4330
Fax Number	:

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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