MEDICARE: MASSIEL ALVAREZ RODRIGUEZ

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-24-340801	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A416-540-96-554-0	OTHER	FL	DL

General Provider Information

NPI Number	:	1952145310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASSIEL ALVAREZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	1754 W 59TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7906
Country	:	US
Telephone Number	:	305-613-7608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1754 W 59TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7906
Country	:	US
Telephone Number	:	305-613-7608
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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