MEDICARE: MASSIEL CHAMORRO RBT

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-21-155931	FL

General Provider Information

NPI Number	:	1992372049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASSIEL CHAMORRO RBT

Provider Business Mailing Address
First Line	:	18341 NE 21ST AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-5017
Country	:	US
Telephone Number	:	786-862-9749
Fax Number	:

Provider Business Practice Location Address
First Line	:	18341 NE 21ST AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-5017
Country	:	US
Telephone Number	:	786-862-9749
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/08/2021

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