MEDICARE: DIANELVYS MARRERO GUTIERREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	1017453	FL

General Provider Information

NPI Number	:	1295678662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANELVYS MARRERO GUTIERREZ

Provider Business Mailing Address
First Line	:	20809 SAILFISH LN
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3223
Country	:	US
Telephone Number	:	305-205-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	20809 SAILFISH LN
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3223
Country	:	US
Telephone Number	:	305-205-3602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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