Provider Demographics
NPI:1750949491
Name:ECHEVARRIA MOLEIRO, MAITE
Entity type:Individual
Prefix:
First Name:MAITE
Middle Name:
Last Name:ECHEVARRIA MOLEIRO
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 1:5224 W 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4023
Mailing Address - Country:US
Mailing Address - Phone:786-675-9029
Mailing Address - Fax:786-842-3815
Practice Address - Street 1:5224 W 26TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4023
Practice Address - Country:US
Practice Address - Phone:786-675-9029
Practice Address - Fax:786-842-3815
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician