Provider Demographics
NPI:1710764378
Name:ROBAINA BOLIGAN, MARLON ALAIN
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:ALAIN
Last Name:ROBAINA BOLIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 W 46TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7170
Mailing Address - Country:US
Mailing Address - Phone:786-670-1966
Mailing Address - Fax:
Practice Address - Street 1:1480 W 46TH ST APT 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7170
Practice Address - Country:US
Practice Address - Phone:786-670-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-288589106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician