MEDICARE: PEDIATRIC ABA 6 INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942791132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ABA 6 INC

Provider Business Mailing Address
First Line	:	1010 E SILVER SPRINGS BLVD STE L
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6763
Country	:	US
Telephone Number	:	786-597-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E SILVER SPRINGS BLVD STE L
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6763
Country	:	US
Telephone Number	:	786-597-2047
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WANDY CACERES
Credential	:	ABAB
Telephone Number	:	786-597-2047

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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