Provider Demographics
NPI:1457182487
Name:LEON LLANES, MARIETTA
Entity type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:LEON LLANES
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 1:19741 SW 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1073
Mailing Address - Country:US
Mailing Address - Phone:786-442-0860
Mailing Address - Fax:
Practice Address - Street 1:19741 SW 114TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1073
Practice Address - Country:US
Practice Address - Phone:786-442-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362419106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician