Provider Demographics
NPI:1558718163
Name:ARTEAGA, MARIALIS (RBT)
Entity Type:Individual
Prefix:
First Name:MARIALIS
Middle Name:
Last Name:ARTEAGA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FLAGAMI BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2661
Mailing Address - Country:US
Mailing Address - Phone:786-683-3611
Mailing Address - Fax:
Practice Address - Street 1:59 FLAGAMI BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2661
Practice Address - Country:US
Practice Address - Phone:786-683-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst