MEDICARE: RAQUEL PUENTE SERRANO

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	103K00000X	Behavior Analyst	1-25-86861	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	:	1952025298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL PUENTE SERRANO

Provider Business Mailing Address
First Line	:	3702 NW 188TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2857
Country	:	US
Telephone Number	:	786-568-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2879 SW ANN ARBOR RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6924
Country	:	US
Telephone Number	:	786-413-5699
Fax Number	:

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

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	02/25/2026

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Directions to “ RAQUEL PUENTE SERRANO ” Practice Location

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