Provider Demographics
NPI:1033998950
Name:MARTINEZ SAMPER, AMANDA MARIA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA
Last Name:MARTINEZ SAMPER
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 1:7108 SW 103RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1377
Mailing Address - Country:US
Mailing Address - Phone:305-766-8204
Mailing Address - Fax:
Practice Address - Street 1:7108 SW 103RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1377
Practice Address - Country:US
Practice Address - Phone:305-766-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23300517106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician