Provider Demographics
NPI:1083063150
Name:MARTINEZ, LESBIA YESENIA
Entity Type:Individual
Prefix:MRS
First Name:LESBIA
Middle Name:YESENIA
Last Name:MARTINEZ
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 1:155 NW 193RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3321
Mailing Address - Country:US
Mailing Address - Phone:786-334-9831
Mailing Address - Fax:
Practice Address - Street 1:155 NW 193RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-3321
Practice Address - Country:US
Practice Address - Phone:786-334-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician