Provider Demographics
NPI:1750961371
Name:TAMAYO PADRON, GREISY
Entity type:Individual
Prefix:
First Name:GREISY
Middle Name:
Last Name:TAMAYO PADRON
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 1:10830 SW 84TH ST APT D2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3854
Mailing Address - Country:US
Mailing Address - Phone:239-601-4986
Mailing Address - Fax:
Practice Address - Street 1:10830 SW 84TH ST APT D2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3854
Practice Address - Country:US
Practice Address - Phone:239-601-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20137197106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician