MEDICARE: KEVIN RENAN LEYVA BARREDA

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-24-349232	FL

General Provider Information

NPI Number	:	1992546022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN RENAN LEYVA BARREDA

Provider Business Mailing Address
First Line	:	765 HUMMINGBIRD LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7830
Country	:	US
Telephone Number	:	786-644-8693
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-5745
Country	:	US
Telephone Number	:	407-602-7442
Fax Number	:	786-631-4483

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	05/28/2026

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