Provider Demographics
NPI:1740024942
Name:MUNOZ MARQUEZ, YERAL
Entity type:Individual
Prefix:
First Name:YERAL
Middle Name:
Last Name:MUNOZ MARQUEZ
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 1:15447 SW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1370
Mailing Address - Country:US
Mailing Address - Phone:305-384-5384
Mailing Address - Fax:
Practice Address - Street 1:15447 SW 171ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1370
Practice Address - Country:US
Practice Address - Phone:305-384-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-350996106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician