Provider Demographics
NPI:1093584542
Name:MOTA MARTINEZ, FLOR JASMINE
Entity Type:Individual
Prefix:
First Name:FLOR
Middle Name:JASMINE
Last Name:MOTA 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 1:1817 DEMASTUS LN
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3717
Mailing Address - Country:US
Mailing Address - Phone:407-267-8313
Mailing Address - Fax:
Practice Address - Street 1:1817 DEMASTUS LN
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3717
Practice Address - Country:US
Practice Address - Phone:407-267-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1004836103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst