Provider Demographics
NPI:1215578802
Name:MARTINEZ HONDARES, NAYIVIS
Entity Type:Individual
Prefix:
First Name:NAYIVIS
Middle Name:
Last Name:MARTINEZ HONDARES
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 1:2231 SW 43RD TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6633
Mailing Address - Country:US
Mailing Address - Phone:954-790-2450
Mailing Address - Fax:954-893-9455
Practice Address - Street 1:5625 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6100
Practice Address - Country:US
Practice Address - Phone:954-893-9499
Practice Address - Fax:954-893-9455
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
FLRBT-23-309087106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251E00000XAgenciesHome Health