Provider Demographics
NPI:1578112041
Name:MILIAN, MAYELIN
Entity Type:Individual
Prefix:
First Name:MAYELIN
Middle Name:
Last Name:MILIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6575 W 4TH AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6668
Mailing Address - Country:US
Mailing Address - Phone:786-306-2983
Mailing Address - Fax:
Practice Address - Street 1:6575 W 4TH AVE APT 310
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6668
Practice Address - Country:US
Practice Address - Phone:786-306-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty