Provider Demographics
NPI:1679305718
Name:MARRERO TRABA, ROLANDO I
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:I
Last Name:MARRERO TRABA
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 1:15321 SW 112TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1174
Mailing Address - Country:US
Mailing Address - Phone:954-309-7264
Mailing Address - Fax:
Practice Address - Street 1:15321 SW 112TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1174
Practice Address - Country:US
Practice Address - Phone:954-309-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-8595-759304106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician