Provider Demographics
NPI:1669256897
Name:MARIN LEON, YENISBEL
Entity type:Individual
Prefix:
First Name:YENISBEL
Middle Name:
Last Name:MARIN LEON
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 1:9520 SW 8TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3066
Mailing Address - Country:US
Mailing Address - Phone:786-320-1809
Mailing Address - Fax:
Practice Address - Street 1:9520 SW 8TH ST APT 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3066
Practice Address - Country:US
Practice Address - Phone:786-320-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-291422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician