Provider Demographics
NPI:1053131763
Name:MESA ALONSO, MARIALYS (RBT)
Entity type:Individual
Prefix:
First Name:MARIALYS
Middle Name:
Last Name:MESA ALONSO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 W FLAGLER ST APT 31
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1575
Mailing Address - Country:US
Mailing Address - Phone:786-804-8075
Mailing Address - Fax:
Practice Address - Street 1:2103 CORAL WAY STE 603
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2656
Practice Address - Country:US
Practice Address - Phone:786-464-0353
Practice Address - Fax:786-483-8142
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRBT-24346160106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician