Provider Demographics
NPI:1710762117
Name:PADRON MARQUEZ, YARISLEIVY
Entity Type:Individual
Prefix:
First Name:YARISLEIVY
Middle Name:
Last Name:PADRON 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 1:10985 SW 214TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3154
Mailing Address - Country:US
Mailing Address - Phone:786-710-8164
Mailing Address - Fax:
Practice Address - Street 1:14201 SW 120TH ST STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7662
Practice Address - Country:US
Practice Address - Phone:786-710-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician