Healthcare Provider Details

I. General information

NPI: 1043981236
Provider Name (Legal Business Name): MARLEN MEJIAS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLEN PORTELA

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 SE 46TH LN
CAPE CORAL FL
33904-8617
US

IV. Provider business mailing address

5050 TAMIAMI TRL N STE B
NAPLES FL
34103-2853
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-3318
  • Fax: 239-673-6895
Mailing address:
  • Phone: 239-351-0675
  • Fax: 239-631-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-172850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: