MEDICARE: RAQUEL IBARRA MERA

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	18-69908	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	:	1942737416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL IBARRA MERA

Provider Business Mailing Address
First Line	:	8180 NW 36TH ST STE 209
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33166-6653
Country	:	US
Telephone Number	:	786-334-6946
Fax Number	:	786-313-3079

Provider Business Practice Location Address
First Line	:	3724 SW 149TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3928
Country	:	US
Telephone Number	:	305-805-5874
Fax Number	:

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

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	02/22/2022

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Directions to “ RAQUEL IBARRA MERA ” Practice Location

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