Provider Demographics
NPI:1366315798
Name:OLIVA MARRERO, DIOSALET
Entity type:Individual
Prefix:
First Name:DIOSALET
Middle Name:
Last Name:OLIVA MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8552 CLARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2849
Mailing Address - Country:US
Mailing Address - Phone:305-989-1770
Mailing Address - Fax:
Practice Address - Street 1:8552 CLARIDGE DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2849
Practice Address - Country:US
Practice Address - Phone:305-989-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1000176106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty