Healthcare Provider Details

I. General information

NPI: 1730788225
Provider Name (Legal Business Name): MARLA BEATRIZ RODRIGUEZ GALLARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BAYVIEW DR APT 1803
SUNNY ISLES BEACH FL
33160-4747
US

IV. Provider business mailing address

300 BAYVIEW DR APT 1803
SUNNY ISLES BEACH FL
33160-4747
US

V. Phone/Fax

Practice location:
  • Phone: 786-499-6126
  • Fax:
Mailing address:
  • Phone: 786-499-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72729
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: