Provider Demographics
NPI:1912664699
Name:MARQUEZ MEDEROS, ARLETH
Entity Type:Individual
Prefix:
First Name:ARLETH
Middle Name:
Last Name:MARQUEZ MEDEROS
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 1:22615 SW 102ND CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1757
Mailing Address - Country:US
Mailing Address - Phone:786-714-7917
Mailing Address - Fax:
Practice Address - Street 1:22615 SW 102ND CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1757
Practice Address - Country:US
Practice Address - Phone:786-714-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-191565106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM622004967200Medicaid