MEDICARE: LEON MARMOL OCANA BCBA

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	103K00000X	Behavior Analyst	BCBA-1-22-61416	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	:	1629696661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEON MARMOL OCANA BCBA

Provider Business Mailing Address
First Line	:	4541 W 14TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3328
Country	:	US
Telephone Number	:	786-821-4291
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 NW 77TH AVE
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2530
Country	:	US
Telephone Number	:	786-456-1095
Fax Number	:

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	05/13/2023

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