Healthcare Provider Details

I. General information

NPI: 1770090714
Provider Name (Legal Business Name): REBECA ELIZABETH MARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO PARK 7, STREET #1 SUITE 204
GUAYNABO PR
00968
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

V. Phone/Fax

Practice location:
  • Phone: 941-822-1605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: