Provider Demographics
NPI:1033871983
Name:MARTINEZ PEREZ, ADA LILIAN
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:LILIAN
Last Name:MARTINEZ PEREZ
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 1:11706 SW 242ND TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5102
Mailing Address - Country:US
Mailing Address - Phone:786-634-7038
Mailing Address - Fax:
Practice Address - Street 1:11706 SW 242ND TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5102
Practice Address - Country:US
Practice Address - Phone:786-634-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty