MEDICARE: DANISLEY MARIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982110946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANISLEY MARIN

Provider Business Mailing Address
First Line	:	6365 W 24TH AVE APT 19
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-3990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6365 W 24TH AVE APT 19
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-3990
Country	:	US
Telephone Number	:	786-609-0880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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Directions to “ DANISLEY MARIN ” Practice Location

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