MEDICARE: MARILOLY ROBERT VINALES

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	23-318565	FL

General Provider Information

NPI Number	:	1851160998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILOLY ROBERT VINALES

Provider Business Mailing Address
First Line	:	425 SAN MATEO DR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1521
Country	:	US
Telephone Number	:	904-884-6058
Fax Number	:

Provider Business Practice Location Address
First Line	:	4793 N CONGRESS AVE STE 203
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7937
Country	:	US
Telephone Number	:	561-429-3863
Fax Number	:	561-448-6063

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

Provider Enumeration Date	:	01/01/2024
Last Update Date	:	04/29/2026

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