Provider Demographics
NPI:1700634011
Name:PRADO ROJAS, MARLENIS
Entity Type:Individual
Prefix:
First Name:MARLENIS
Middle Name:
Last Name:PRADO ROJAS
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 1:275 NW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4320
Mailing Address - Country:US
Mailing Address - Phone:786-304-7026
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST STE 660
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3485
Practice Address - Country:US
Practice Address - Phone:305-900-2361
Practice Address - Fax:305-900-2371
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0105277171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator