MEDICARE: ANET MARTINEZ TACORONTE MS, BCBA

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	106E00000X	Assistant Behavior Analyst	0-20-11660	FL
2	106S00000X	Behavior Technician	RBT-18-55283	FL
3	103K00000X	Behavior Analyst	1-22-57830	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	:	1962067397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANET MARTINEZ TACORONTE MS, BCBA

Provider Business Mailing Address
First Line	:	7108 SW 103RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1377
Country	:	US
Telephone Number	:	305-930-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	7108 SW 103RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1377
Country	:	US
Telephone Number	:	305-930-9811
Fax Number	:

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

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	05/22/2023

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