Healthcare Provider Details

I. General information

NPI: 1740115732
Provider Name (Legal Business Name): MAYLIN CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17255 SW 95TH AVE APT J125
PALMETTO BAY FL
33157-4453
US

IV. Provider business mailing address

17255 SW 95TH AVE
PALMETTO BAY FL
33157-4453
US

V. Phone/Fax

Practice location:
  • Phone: 786-740-0145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-424533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: