Provider Demographics
NPI:1902303811
Name:MAYORAL MACHADO, ODEN ANGEL
Entity Type:Individual
Prefix:
First Name:ODEN
Middle Name:ANGEL
Last Name:MAYORAL MACHADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16285 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5325
Mailing Address - Country:US
Mailing Address - Phone:786-266-2942
Mailing Address - Fax:
Practice Address - Street 1:16285 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5325
Practice Address - Country:US
Practice Address - Phone:786-266-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst