Provider Demographics
NPI:1598290835
Name:PRIETO IGLESIAS, MAYLIN
Entity Type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:PRIETO IGLESIAS
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 1:9031 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2836
Mailing Address - Country:US
Mailing Address - Phone:786-498-2847
Mailing Address - Fax:
Practice Address - Street 1:9031 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147
Practice Address - Country:US
Practice Address - Phone:786-498-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician