Healthcare Provider Details

I. General information

NPI: 1629696661
Provider Name (Legal Business Name): LEON MARMOL OCANA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15271 NW 60TH AVE STE 104
MIAMI LAKES FL
33014-2431
US

IV. Provider business mailing address

15271 NW 60TH AVE STE 104
MIAMI LAKES FL
33014-2431
US

V. Phone/Fax

Practice location:
  • Phone: 786-821-4291
  • Fax: 786-991-9163
Mailing address:
  • Phone: 786-821-4291
  • Fax: 786-991-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-22-61416
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: