Provider Demographics
NPI:1770324477
Name:PERIUT CANDELARIO, MARIALINA
Entity type:Individual
Prefix:
First Name:MARIALINA
Middle Name:
Last Name:PERIUT CANDELARIO
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 1:4781 ORANGE GROVE BLVD APT 10
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4588
Mailing Address - Country:US
Mailing Address - Phone:239-214-4934
Mailing Address - Fax:
Practice Address - Street 1:12553 NEW BRITTANY BLVD STE 3210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3625
Practice Address - Country:US
Practice Address - Phone:239-691-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician