Provider Demographics
NPI:1063843837
Name:MARTINEZ, NEDELKA GABRIELA (BCBA)
Entity Type:Individual
Prefix:
First Name:NEDELKA
Middle Name:GABRIELA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-200 KUALII PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3766
Mailing Address - Country:US
Mailing Address - Phone:352-434-9713
Mailing Address - Fax:
Practice Address - Street 1:99-950 IWAENA ST FL 2
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5645
Practice Address - Country:US
Practice Address - Phone:808-277-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-14078103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst