Healthcare Provider Details

I. General information

NPI: 1013509801
Provider Name (Legal Business Name): MISS MARILIN MOSQUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST STE 203
MIAMI FL
33125-4141
US

IV. Provider business mailing address

275 SW 43RD AVE
CORAL GABLES FL
33134-1754
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax:
Mailing address:
  • Phone: 786-340-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-21-153814
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-153814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: