Provider Demographics
NPI:1336870773
Name:MARIBONA, MARISLEYDIS
Entity Type:Individual
Prefix:
First Name:MARISLEYDIS
Middle Name:
Last Name:MARIBONA
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 1:16480 SW 304TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3276
Mailing Address - Country:US
Mailing Address - Phone:786-567-1121
Mailing Address - Fax:
Practice Address - Street 1:11625 SW 98TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4107
Practice Address - Country:US
Practice Address - Phone:786-458-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician