Provider Demographics
NPI:1629696661
Name:MARMOL OCANA, LEON (BCBA)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:MARMOL OCANA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 W 14TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3328
Mailing Address - Country:US
Mailing Address - Phone:786-821-4291
Mailing Address - Fax:
Practice Address - Street 1:9500 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2530
Practice Address - Country:US
Practice Address - Phone:786-456-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBCBA-1-22-61416103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105402500Medicaid