Healthcare Provider Details

I. General information

NPI: 1770974818
Provider Name (Legal Business Name): DAVID MARQUINO CAJIAO M.S., M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE 206
COCONUT GROVE FL
33133-2740
US

IV. Provider business mailing address

2780 SW 37TH AVE 206
COCONUT GROVE FL
33133-2740
US

V. Phone/Fax

Practice location:
  • Phone: 305-496-8416
  • Fax:
Mailing address:
  • Phone: 305-496-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT1123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: