Provider Demographics
NPI:1891279022
Name:MARRERO AVILA, DORY
Entity Type:Individual
Prefix:
First Name:DORY
Middle Name:
Last Name:MARRERO AVILA
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 1:6090 W 18TH AVE APT 337
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6169
Mailing Address - Country:US
Mailing Address - Phone:786-468-0179
Mailing Address - Fax:
Practice Address - Street 1:2300 W 84TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5770
Practice Address - Country:US
Practice Address - Phone:305-456-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician