MEDICARE: MARLON MIRANDA HERNANDEZ

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	RBT20-142752	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417664095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLON MIRANDA HERNANDEZ

Provider Business Mailing Address
First Line	:	1960 MARSEILLE DR APT 306
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-4753
Country	:	US
Telephone Number	:	786-222-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 MARSEILLE DR APT 306
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-4753
Country	:	US
Telephone Number	:	786-222-5599
Fax Number	:

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

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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Directions to “ MARLON MIRANDA HERNANDEZ ” Practice Location

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