Healthcare Provider Details

I. General information

NPI: 1043132095
Provider Name (Legal Business Name): MARIFERNANDA D MAYORAL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15569 SW 138TH PL
MIAMI FL
33177-1170
US

IV. Provider business mailing address

15569 SW 138TH PL
MIAMI FL
33177-1170
US

V. Phone/Fax

Practice location:
  • Phone: 786-614-2672
  • Fax:
Mailing address:
  • Phone: 786-614-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-539247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: