Healthcare Provider Details

I. General information

NPI: 1578682563
Provider Name (Legal Business Name): ROSSNIEL MARINAS DPT - BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 W 100TH TER
HIALEAH FL
33018-2102
US

IV. Provider business mailing address

3351 W 100TH TER
HIALEAH FL
33018-2102
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-1776
  • Fax:
Mailing address:
  • Phone: 305-979-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-23-65381
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 21736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: