Provider Demographics
NPI:1538918024
Name:PUERTA, MARIAN BEATRIZ
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:BEATRIZ
Last Name:PUERTA
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 1:8290 LAKE DR APT 126
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4629
Mailing Address - Country:US
Mailing Address - Phone:305-742-7287
Mailing Address - Fax:
Practice Address - Street 1:8290 LAKE DR APT 126
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4629
Practice Address - Country:US
Practice Address - Phone:305-742-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-346211106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician