Provider Demographics
NPI:1639671464
Name:FONG MARQUEZ, YAMILEE
Entity Type:Individual
Prefix:
First Name:YAMILEE
Middle Name:
Last Name:FONG MARQUEZ
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 1:10250 NW 80TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2260
Mailing Address - Country:US
Mailing Address - Phone:786-217-2007
Mailing Address - Fax:
Practice Address - Street 1:10250 NW 80TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2260
Practice Address - Country:US
Practice Address - Phone:786-217-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty