Provider Demographics
NPI:1013535368
Name:MARTINEZ LEON, YANA ANIBIS
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:ANIBIS
Last Name:MARTINEZ 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 1:7160 W 10TH CT APT 4B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4677
Mailing Address - Country:US
Mailing Address - Phone:786-925-0500
Mailing Address - Fax:
Practice Address - Street 1:7160 W 10TH CT APT 4B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4677
Practice Address - Country:US
Practice Address - Phone:786-925-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-126320106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician