Provider Demographics
NPI:1386139186
Name:AGUILAR VALERA, MARLLEBIS DEYANIRA (SA-C)
Entity type:Individual
Prefix:
First Name:MARLLEBIS
Middle Name:DEYANIRA
Last Name:AGUILAR VALERA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 SW 147TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4437
Mailing Address - Country:US
Mailing Address - Phone:786-971-8522
Mailing Address - Fax:
Practice Address - Street 1:2257 SW 147TH PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4437
Practice Address - Country:US
Practice Address - Phone:786-971-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-791246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant