Provider Demographics
NPI:1477273597
Name:GILBERT, MARQUIS
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MICHIGAN AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6054
Mailing Address - Country:US
Mailing Address - Phone:414-687-5997
Mailing Address - Fax:
Practice Address - Street 1:15165 NW 77TH AVE STE 1002
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7825
Practice Address - Country:US
Practice Address - Phone:414-687-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician