Provider Demographics
NPI:1821852211
Name:QUERIN, MAYVIS DURAN
Entity Type:Individual
Prefix:
First Name:MAYVIS
Middle Name:DURAN
Last Name:QUERIN
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 1:9135 SW 125TH AVE APT 102P
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7112
Mailing Address - Country:US
Mailing Address - Phone:305-283-0863
Mailing Address - Fax:
Practice Address - Street 1:10300 SUNSET DR STE 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3038
Practice Address - Country:US
Practice Address - Phone:305-822-9063
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician