Healthcare Provider Details

I. General information

NPI: 1972107134
Provider Name (Legal Business Name): MARISOL ESQUIVEL CEREIJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NW 78TH TER APT 205
PEMBROKE PINES FL
33024-1216
US

IV. Provider business mailing address

301 NW 78TH TER APT 205
PEMBROKE PINES FL
33024-1216
US

V. Phone/Fax

Practice location:
  • Phone: 954-328-7229
  • Fax:
Mailing address:
  • Phone: 954-328-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-146065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: