Provider Demographics
NPI:1568819597
Name:CARBAJAL, MIRELYS
Entity type:Individual
Prefix:
First Name:MIRELYS
Middle Name:
Last Name:CARBAJAL
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 1:1807 CHAPEL TREE CIR APT G
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-9332
Mailing Address - Country:US
Mailing Address - Phone:786-803-4312
Mailing Address - Fax:
Practice Address - Street 1:1807 CHAPEL TREE CIR APT G
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-9332
Practice Address - Country:US
Practice Address - Phone:786-803-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician