Provider Demographics
NPI:1093226128
Name:MARTINEZ, YASHIRA NELLIE (BCBA)
Entity Type:Individual
Prefix:
First Name:YASHIRA
Middle Name:NELLIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:YASHIRA
Other - Middle Name:NELLIE
Other - Last Name:RIVERA-SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1510 OAK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2816
Mailing Address - Country:US
Mailing Address - Phone:239-319-9986
Mailing Address - Fax:
Practice Address - Street 1:1510 OAK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2816
Practice Address - Country:US
Practice Address - Phone:239-841-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-34018106S00000X
222Q00000X
1-21-53860103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021240200Medicaid