MEDICARE: ADIALYS COLINA 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	RBT-20-125986	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	:	1932871001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADIALYS COLINA RBT

Provider Business Mailing Address
First Line	:	4050 NW 135TH ST APT 1-5
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33054-4630
Country	:	US
Telephone Number	:	954-397-0973
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 NW 135TH ST APT 1-5
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33054-4630
Country	:	US
Telephone Number	:	954-397-0973
Fax Number	:

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

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	03/25/2026

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Directions to “ ADIALYS COLINA RBT” Practice Location

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