Healthcare Provider Details

I. General information

NPI: 1417721663
Provider Name (Legal Business Name): MARCOS EDEL SANCHEZ MARICHAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18725 NW 23RD AVE
MIAMI GARDENS FL
33056-3226
US

IV. Provider business mailing address

18725 NW 23RD AVE
MIAMI GARDENS FL
33056-3226
US

V. Phone/Fax

Practice location:
  • Phone: 786-718-9609
  • Fax:
Mailing address:
  • Phone: 786-718-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-296542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: