Provider Demographics
NPI:1285382382
Name:MAYO OCANA, MARVELIS
Entity type:Individual
Prefix:
First Name:MARVELIS
Middle Name:
Last Name:MAYO OCANA
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 1:11831 SW 210TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7003
Mailing Address - Country:US
Mailing Address - Phone:786-710-5025
Mailing Address - Fax:
Practice Address - Street 1:15190 SW 136TH ST STE 26
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2618
Practice Address - Country:US
Practice Address - Phone:786-710-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-118953106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112942000Medicaid