Provider Demographics
NPI:1114689965
Name:MARTINEZ, YANNIEL
Entity Type:Individual
Prefix:MR
First Name:YANNIEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:YANNIEL
Other - Middle Name:
Other - Last Name:MARTINEZ MESA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1436 E MOWRY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4963
Mailing Address - Country:US
Mailing Address - Phone:786-202-2245
Mailing Address - Fax:
Practice Address - Street 1:13331 SW 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2309
Practice Address - Country:US
Practice Address - Phone:786-202-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-168727106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician