Healthcare Provider Details

I. General information

NPI: 1710593991
Provider Name (Legal Business Name): ODALIS DE LAS MERCEDES MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2744 SW 175TH LOOP
OCALA FL
34473-4441
US

IV. Provider business mailing address

2744 SW 175TH LOOP
OCALA FL
34473-4441
US

V. Phone/Fax

Practice location:
  • Phone: 786-675-9955
  • Fax:
Mailing address:
  • Phone: 786-675-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: