Provider Demographics
NPI:1912883737
Name:CEBALLO ECHEVARRIA, MAIRELYS
Entity type:Individual
Prefix:
First Name:MAIRELYS
Middle Name:
Last Name:CEBALLO ECHEVARRIA
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 1:26655 SW 142ND AVE APT 26655SW
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5450
Mailing Address - Country:US
Mailing Address - Phone:786-992-8719
Mailing Address - Fax:
Practice Address - Street 1:26655 SW 142ND AVE APT 26655SW
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5450
Practice Address - Country:US
Practice Address - Phone:786-992-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician