Healthcare Provider Details

I. General information

NPI: 1477257517
Provider Name (Legal Business Name): MARIEL D ESPINOSA SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17780 SW 107TH AVE APT 203
MIAMI FL
33157-0825
US

IV. Provider business mailing address

17780 SW 107TH AVE APT 203
MIAMI FL
33157-0825
US

V. Phone/Fax

Practice location:
  • Phone: 786-486-3394
  • Fax:
Mailing address:
  • Phone: 786-486-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-257813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: