Provider Demographics
NPI:1821600297
Name:MARCOS, FANNY
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:
Last Name:MARCOS
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 1:9409 FONTAINEBLEAU BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5516
Mailing Address - Country:US
Mailing Address - Phone:786-624-1601
Mailing Address - Fax:
Practice Address - Street 1:9409 FONTAINEBLEAU BLVD APT 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5516
Practice Address - Country:US
Practice Address - Phone:786-624-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty