Provider Demographics
NPI:1164299442
Name:MARTELL, ALEJANDRO ESTEBAN
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ESTEBAN
Last Name:MARTELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 SW 150TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2579
Mailing Address - Country:US
Mailing Address - Phone:786-316-1939
Mailing Address - Fax:
Practice Address - Street 1:1071 SW 150TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2579
Practice Address - Country:US
Practice Address - Phone:786-316-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-311639106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician