Provider Demographics
NPI:1669757407
Name:MARICHAL, RUBEN (RBT)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MARICHAL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10375 N KENDALL DR
Mailing Address - Street 2:APARTMENT J-4
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1675
Mailing Address - Country:US
Mailing Address - Phone:305-323-1743
Mailing Address - Fax:305-764-3505
Practice Address - Street 1:8841 SW 25TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2018
Practice Address - Country:US
Practice Address - Phone:305-323-1743
Practice Address - Fax:305-764-3505
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43722225700000X
FLRBT20147518106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist