MEDICARE: PROMORA BEHAVIORAL LLC

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

General Provider Information

NPI Number	:	1972449882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMORA BEHAVIORAL LLC

Provider Business Mailing Address
First Line	:	9823 7TH AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-7255
Country	:	US
Telephone Number	:	407-715-2995
Fax Number	:

Provider Business Practice Location Address
First Line	:	9823 7TH AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-7255
Country	:	US
Telephone Number	:	407-715-2995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIZ MERARI VEGA MARTINEZ
Credential	:
Telephone Number	:	407-715-2995

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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Directions to “PROMORA BEHAVIORAL LLC ” Practice Location

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