Healthcare Provider Details

I. General information

NPI: 1710762117
Provider Name (Legal Business Name): YARISLEIVY PADRON MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22133 S DIXIE HWY
MIAMI FL
33170-2840
US

IV. Provider business mailing address

10985 SW 214TH ST APT 201
MIAMI FL
33189-3154
US

V. Phone/Fax

Practice location:
  • Phone: 786-504-3119
  • Fax: 954-206-2835
Mailing address:
  • Phone: 786-710-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26732
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: