Healthcare Provider Details

I. General information

NPI: 1578425856
Provider Name (Legal Business Name): MARLOIDY FIDALGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18341 NW 39TH CT
MIAMI GARDENS FL
33055-2821
US

IV. Provider business mailing address

98 NE 5TH AVE
HIALEAH FL
33010-5043
US

V. Phone/Fax

Practice location:
  • Phone: 786-782-6043
  • Fax: 786-782-6043
Mailing address:
  • Phone: 786-782-6043
  • Fax: 786-782-6043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-494098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: