Provider Demographics
NPI:1316710676
Name:ALEJO GOMEZ, MARLON
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:ALEJO GOMEZ
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 1:15451 SW 80TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2614
Mailing Address - Country:US
Mailing Address - Phone:561-460-5762
Mailing Address - Fax:
Practice Address - Street 1:15451 SW 80TH ST APT 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2614
Practice Address - Country:US
Practice Address - Phone:561-460-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-293316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician