Healthcare Provider Details

I. General information

NPI: 1164870341
Provider Name (Legal Business Name): MARYURI LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2016
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 NW 59TH CT
MIAMI FL
33126-3138
US

IV. Provider business mailing address

410 NW 59TH CT
MIAMI FL
33126-3138
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-9156
  • Fax:
Mailing address:
  • Phone: 786-556-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: